727 Ultraradical cytoreductive surgery with nodes dissection from hepatoduodenal ligament – are there any limits in surgical oncology?

Introduction/Background Ultraradical cytoreductive surgery aiming to achieve complete removal of all malignant lesions is increasingly receiving attention as the results of prospective studies provided evidence for longer OS and PFS compered to standard protocols. However, proper prehabilitation program and sophistical surgical techniques are essential to achieve radicality. Methodology 73-years old women diagnosed with HGSOC FIGO IVA (malignant pleural effusion) were qualified for ultra-cytoreductive surgery. In preoperative CT scan enlarged nodes in hepatoduodenal ligament (34x39 mm), above pancreas head (23x20 mm) as well as infiltration of stomach wall in greater curvature (29x33 mm) were described. Additionally, bulky nodes (30x23 mm) under left renal vain were detected. The patient underwent prehabilitation program according to local policy. No metastasis to lung and liver were detected. Results Ultraradical cytoreductive surgery lasted 515 minutes and included en-block hysterectomy with ovarian tumors, sigmoid, rectum and pelvic peritoneum, total peritonectomy, diaphragmatic striping, splenectomy, radical omentectomy, lesser omentum resection, abdominal peritonectomy, gastric tumor resection, metastatic tumors resection from transverse colon and mesenteric root, appendectomy, aortal bulky nodes dissection, removal of nodes from hepatoduodenal ligament and pancreas head. End to end colo-rectal anastomosis was also performed. After the surgery the patient was transfer to Intensive Care Unit for 3 days. No major complication was detected. The patient was discharged on 11th postoperative day. Partial portal vein thrombosis was detected and LMWH were administered. In final histopathological results metastatic nodes were described. The patient was referred for adjuvant CTH. Conclusion Ultraradical cytoreductive surgery for HGSOC is feasible However, proper selection of patients is essential. Disclosures None.