Secondary cytoreductive surgery: Surgical approach to bulky aortic nodes, splenic metastases and mesenteric disease

Ovarian cancer is the third most common gynecological malignancy and the second cause of cancer death worldwide. About 80% of women affected by advanced ovarian cancer is destined to suffer a relapse after completion of first-line treatment. Whereas, it is generally accepted, that treatment of primary disease should include cytoreductive surgery and platinum based chemotherapy, no unanimous acceptance on the treatment of disease relapse has been reached. In recent years, surgical treatment of ovarian cancer disease recurrence has acquired increasing consensus and since the first reports, Authors are defining appropriate indications and survival results. Comparative studies have suggested that women who achieve optimal residual disease after secondary cytoreduction (SCR) have better outcomes than similar patients treated with sole chemotherapy. Gynecologists that approach this type of surgery require a deep knowledge of the retroperitoneal, vascular and upper abdominal anatomy. Here we present the technique we adopt to remove disease recurrence from three common and most challenging sites.