1094 Secondary cytoreductive surgery for type IV recurrent granulosa cell tumor according to gemelli anatomo-surgical classification of ovarian cancer metastases in the liver area

Introduction/Background We recently introduced an anatomo-surgical classification for ovarian cancer metastases in the liver area. This classification system aids in stratifying surgical complexity, guiding surgical planning, indicating the need for different surgical expertise, and predicting potential intra- and postoperative complications. Methodology We present the case of a 52-year-old patient diagnosed with a recurrent pelvic and hepato-diaphragmatic recurrence of an ovarian granulosa cell tumor. Imaging review within a multidisciplinary tumor board identified a solid multilocular lesion of 10cm, infiltrating both the VII hepatic segment and the diaphragmatic peritoneum with a full thickness involvement of the central tendon. The perihepatic lesion was classified as 'Class IV' or mixed parenchymal-peritoneal involvement. Results The patient underwent secondary cytoreduction with an open abdominal hysterectomy, bilateral salpingo-oophorectomy, rectosigmoid resection, resection of the 7th hepatic segment, full-thickness diaphragmatic resection, with prosthetic reconstruction. Complete gross resection was achieved thanks to the coordinated intervention of the hepatobiliary and thoracic surgeon. Surgery lasted 250 minutes, with an estimated blood loss of 1200 cc. Intraoperatively, the patient received 3 units of blood transfusion and 1 unit of plasma. Postoperatively, the patient spent 24 hours in intensive care unit and experienced a grade 2 right pleural effusion and a grade 2 systemic infection, both managed with intravenous antibiotics. Discharged on postoperative day 15, the patient showed no additional complications during the 1-month follow-up. Conclusion Preoperative application of the anatomo-surgical classification facilitated effective surgical planning, resulting in successful complete gross resection. Class IV (mixed) exhibited the highest intraoperative complexity, reflected by elevated estimated blood loss and transfusion rates. Class IV patients were prone to develop postoperative complications, particularly pleuric effusion and sepsis. The Gemelli classification allowed for the stratification of surgical outcomes and complications profile, enabling anticipation and optimization of intra- and postoperative strategies and targeted patient counseling Disclosures None.