1057 Total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with para-aortic lymphadenectomy in advanced stage endometrial cancer: a video presentation

Introduction/Background 61 years old female, treated case of Adenoid cystic carcinoma of the scalp, postmenopausal since 9 years, presented with two episodes of postmenopausal bleeding. Her ultrasound was done which showed endometrial thickness of 7mm. Endometrial biopsy was taken which was reported as high grade serous carcinoma/clear cell carcinoma. Imaging studies showed uterine tumor with bilateral enlarged pelvic sidewall, para-aortic and aortocaval nodes with mildly avid peritoneal nodule. Predicted FIGO stage was IVb. Case was discussed in Multidisciplinary team meeting and a plan of primary debulking surgery followed by adjuvant chemotherapy was made. Methodology Intraoperatively, there was a bulky uterus with multiple fibroids, bilateral ovaries were normal looking, uterus was adherent to the anterior abdominal wall. Omentum was adherent to the anterior abdominal wall in the midline and also to the falciform ligament. Multiple enlarged lymph nodes in the bilateral pelvic and para-aortic regions were present. No omento-peritoneal disease was found. Rest of the survey was unremarkable. She underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and systematic pelvic lymphadenectomy with para-aortic lymphadenectomy without any intraoperative complications. Patient remained stable afterwards and discharged home. Results Final histopathology was reported as high grade serous carcinoma of the endometrium. Five pelvic lymph nodes and three para-aortic lymph nodes were positive for metastatic carcinoma. Omentum and peritoneal biopsies were free of tumor. So final FIGO stage was IIIC2. Patient received 6 cycles of chemotherapy afterwards and is doing fine on follow up. Conclusion Laparoscopic surgery seems to be beneficial even in advanced stage endometrial cancers in terms of lesser adverse events related to surgery, postoperative complications and early recovery. Disclosures No conflicts of interest. No source of funding.