A patient in her 60s had previously undergone cytoreductive surgery followed by adjuvant chemotherapy for stage IIIB high-grade serous carcinoma of the fallopian tube. Somatic testing revealed loss of heterozygosity >16% (determined by Foundation Medicine), therefore the patient was placed on maintenance PARPi (poly-(ADP-ribose)-polymerase-1 inhibitor). One year after starting PARPi, the patient had a recurrence. A CT scan revealed peritoneal nodules and a 33.8 mm interaortocaval mass with absent ascites. We opted for laparoscopic resection due to the patient’s extensive co-morbidities and the CT scan showing oligometastatic peritoneal spread. Additionally, previous studies have shown adequate laparoscopic treatment of ovarian cancer.1 2 The patient underwent exploratory laparoscopy with evaluation of the bowel from the ileocecal valve to the ligament of Treitz, mobilization of the duodenum, removal of both the peritoneal nodules and the interaortocaval mass.

On laparoscopic exploration, a suspicious peritoneal nodule was excised and was negative for cancer. During evaluation of the bowel, two mesenteric nodules were fully excised and returned positive. No further metastatic disease was identified within the peritoneum, and the decision was made to proceed with laparoscopic resection of the interaortocaval mass (Figure 1). Following a 2-week recovery, a second regimen of carboplatin/paclitaxel with bevacizumab was administered. After six cycles, PARPi maintenance was restarted. The patient has been disease-free for 2 years.

View of the adherent interaortocaval mass, the lesion is seen to the right of the aorta and just inferior to the duodenum.

We performed conventional laparoscopy to remove residual disease owing to the patient’s medical co-morbidities. The laparoscopic approach expedited recovery, allowing for shorter time to chemotherapy and PARPi maintenance post-operatively. Future considerations may include direct administration of PARPi maintenance without additional chemotherapy as defined by Gauduchon et al.3 Conventional laparoscopy can be indicated in a select group of patients. Gynecologic oncologists' expertise in complex conventional laparoscopy is essential for delivering advanced, minimally invasive care in the absence of robotic surgery. Additionally, choosing conventional laparoscopy in place of robotic techniques can reduce healthcare expenses.4

Not applicable.