Primary Debulking Via Robotic-Assisted Laparoscopy for Stage IIIc Poorly Differentiated Endometrioid Adenocarcinoma of the Ovary.

Abstract

<h3>Study Objective</h3> It has been demonstrated that minimally invasive surgery (MIS) is feasible and effective for interval cytoreduction after neoadjuvant chemotherapy for advanced ovarian cancer patients. MIS is also widely used to assess resectability in the setting of newly diagnosed advanced ovarian cancer. However, the role of MIS in the primary debulking of advanced ovarian cancer is less clear. Here, we present a case of a patient with stage IIIC high-grade endometrioid ovarian cancer, which was optimally debulked to no gross residual(R0) via robotic-assisted laparoscopy. <h3>Design</h3> This is a presentation of a patient who underwent primary ovarian cancer debulking via robotic-assisted laparoscopy. <h3>Setting</h3> The patient was taken to the operating for a planned robotic left ovarian oophorectomy, myomectomy and resection of endometriosis. Diagnostic laparoscopy revealed peritoneal tumor implants consistent with advanced ovarian cancer. The frozen section confirmed epithelial ovarian cancer. <h3>Patients or Participants</h3> This case involves a 37-yo patient who was found to have advanced ovarian cancer at the time of a planned robotic surgery for a complex left ovarian cyst and resection of fibroids and endometriosis. <h3>Interventions</h3> The patient underwent robotic-assisted total hysterectomy, bilateral salpingo-oophorectomy, infracolic omentectomy, resection of pelvic peritoneal, rectosigmoid, and diaphragmatic tumor nodules, pelvic and paraaortic lymph node dissection as well as pelvic washing. Final pathology showed stage IIIC poorly differentiated endometrioid adenocarcinoma of the ovary. <h3>Measurements and Main Results</h3> Complete gross resection (R0) was achieved. The estimated blood loss was 50 cc. The operative time was 3 hours and 10 mins. She was discharged on postoperative day 1. Her postoperative course was uncomplicated. Adjuvant chemotherapy with IV carboplatin and paclitaxel was initiated three weeks after surgery. <h3>Conclusion</h3> MIS is a feasible option for primary debulking in select cases of advanced ovarian cancer.