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Background <p>Isolated parenchymal splenic relapse is a rare condition experienced by patients presenting with recurrent ovarian cancer (ROC).<sup><CitationRef CitationID="CR1">1</CitationRef>–<CitationRef AdditionalCitationIDS="CR2" CitationID="CR3">3</CitationRef></sup> In such cases, complete secondary cytoreductive surgery (SCS) followed by chemotherapy offers significant overall survival benefits for platinum-sensitive ROC patients. Randomized trials such as DESKTOP-3 and SOC-1 described splenectomy during SCS in 6–15% of patients.<sup><CitationRef CitationID="CR4">4</CitationRef>,<CitationRef CitationID="CR5">5</CitationRef></sup> Robotic-assisted surgery (RAS) and advanced three-dimensional (3D) imaging reconstruction can be integrated when choosing minimally invasive surgery (MIS) to reduce the risks associated with splenic procedures.<sup><CitationRef CitationID="CR6">6</CitationRef>–<CitationRef AdditionalCitationIDS="CR7" CitationID="CR8">8</CitationRef></sup></p> Methodology <p>The case of a 70-year-old BRCA2-mutated patient with single-site splenic ROC is presented. Computed tomography (CT) scan was reviewed by an expert radiologist during a multidisciplinary tumor board. The images were manually segmented using 3D Slicer software to obtain the final 3D reconstruction.<sup><CitationRef CitationID="CR9">9</CitationRef></sup> Using the da Vinci Xi™ robot (Intuitive Surgical, Sunnyvale, CA, USA), a medial-to-lateral spleen dissection was performed. Several key surgical steps were followed to avoid tumor manipulation and subsequently minimize potential neoplastic spread.</p> Results <p>Intraoperative ultrasound confirmed lesion localization, and advanced robotic instruments facilitated precise hilum control, reducing the risk of bleeding and pancreatic tail injury. Robotic SCS with complete tumor resection was achieved. No intraoperative or postoperative complications were reported. Final histology confirmed the diagnosis of high-grade ROC.</p> Conclusion <p>RAS represents a viable option for SCS in ROC patients with isolated parenchymal localization. The integration of 3D reconstruction with RAS allows for a tailored approach in complex cases. A high-level of expertise and appropriate identification of candidates for MIS-SCS are required to achieve the best outcomes for ROC patients.</p>

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Robotic Secondary Cytoreduction with 3D Reconstruction for Isolated Recurrent Ovarian Cancer: A Stepwise Approach to Splenectomy

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年3月18日

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  • Riccardo Oliva,
  • Andrea Rosati,
  • Camilla Certelli,
  • Luca Palmieri,
  • Maria Teresa Giudice,
  • Giulia Scaglione,
  • Jacques Marescaux,
  • Giovanni Scambia,
  • Anna Fagotti,
  • Valerio Gallotta

摘要

Background

Isolated parenchymal splenic relapse is a rare condition experienced by patients presenting with recurrent ovarian cancer (ROC).1–3 In such cases, complete secondary cytoreductive surgery (SCS) followed by chemotherapy offers significant overall survival benefits for platinum-sensitive ROC patients. Randomized trials such as DESKTOP-3 and SOC-1 described splenectomy during SCS in 6–15% of patients.4,5 Robotic-assisted surgery (RAS) and advanced three-dimensional (3D) imaging reconstruction can be integrated when choosing minimally invasive surgery (MIS) to reduce the risks associated with splenic procedures.6–8

Methodology

The case of a 70-year-old BRCA2-mutated patient with single-site splenic ROC is presented. Computed tomography (CT) scan was reviewed by an expert radiologist during a multidisciplinary tumor board. The images were manually segmented using 3D Slicer software to obtain the final 3D reconstruction.9 Using the da Vinci Xi™ robot (Intuitive Surgical, Sunnyvale, CA, USA), a medial-to-lateral spleen dissection was performed. Several key surgical steps were followed to avoid tumor manipulation and subsequently minimize potential neoplastic spread.

Results

Intraoperative ultrasound confirmed lesion localization, and advanced robotic instruments facilitated precise hilum control, reducing the risk of bleeding and pancreatic tail injury. Robotic SCS with complete tumor resection was achieved. No intraoperative or postoperative complications were reported. Final histology confirmed the diagnosis of high-grade ROC.

Conclusion

RAS represents a viable option for SCS in ROC patients with isolated parenchymal localization. The integration of 3D reconstruction with RAS allows for a tailored approach in complex cases. A high-level of expertise and appropriate identification of candidates for MIS-SCS are required to achieve the best outcomes for ROC patients.