719 Laparoscopic extraperitoneal debulking of enlarged para-aortic lymph node in patient with endometrial carcinoma recurrence

Introduction/Background The patient is a 47 years old woman with a history of endometrioid endometrial carcinoma FIGO stage IAG2. During a routine follow-up, abdominal CT-scan demonstrated an enlarged para-aortic lymph node suspected for recurrence. PET-TC scan revealed a bulky lymph node with a diameter about 60 mm with no other site of disease. This video describes step-by-step the complete removal of paraaortic bulky nodes by the extraperitoneal laparoscopic approach Methodology In November 2022, the patient underwent lymph node excision by an extraperitoneal laparoscopic approach. After trocar placement, CO2 was insufflated through the pre-peritoneal space. A blunt detachment of adipose tissue was performed, the left psoas and ureter were isolated. After identification of left common iliac artery and para-aortic area, the bulky node was isolated and removed with an endobag. Results Estimated intraoperative blood loss were 200cc. Operative time were 4 hours. The patient was discharged on post operative day 2, no minor or major complications were observed, the final pathology revealed lymph node recurrence of endometrioid adenocarcinoma. After tumor board the patient underwent 4 cycles of Platinum-based chemotherapy and radiotherapy in the para-aortic area. At this moment the patient is free of disease. Conclusion Laparoscopic extraperitoneal lymph node debulking performed by expert gynecologic oncologist seems to be feasible with several advantages comparing to the traditional technique in terms of reduced intraoperative blood loss, less post-operative pain, rapid post-surgery recovery and thereby allowing for early introduction to adjuvant treatment. Disclosures None.