'Salvage cytoreductive surgery for pelvic side wall recurrent endometrial cancer: Robotic combined laterally extended endopelvic resection (LEER) and laterally extended pelvic resection (LEPR) debulking'

Endometrial cancer is the most common gyneco- logical malignancy, and most patients present at an early-­ stage. However, approximately 15% of confined-­ uterus endometrial cancer patients will see their cancer return. Treatment options for recurrent endometrial cancer depend on the patient’s level of fitness, tumor dissemination and prior treatment. For localized resectable pelvic disease, salvage cytore- ductive surgery may improve survival.1 Laterally extended endopelvic resection, en-­ bloc resection of the pelvic tumor and sidewall structures, represents an option for salvage treatment in cases of isolated recurrence involving the pelvic side wall.2 3 In this video we present a robotic combined laterally extended endopelvic resection and laterally extended pelvic resection for recurrent endometrial cancer. The patient was a 59-­ year-­ old woman with a first endometrial cancer recurrence. The initial diagnosis was a well-­ differentiated non myoin- vasive endometrioid adenocarcinoma, staged with hysterectomy and bilateral salpingo-oophorectomy. The patient received no adjuvant treatment and 9 years later experienced the recur- rence. No comorbidities were reported. Imaging showed an isolated lateral relapse in the right obtu- rator fossa involving the ureter, obturator nerve, pelvic muscles, bones side wall and complete infiltration of the external iliac vein and internal iliac vascular compartment. After multidisciplinary tumor board discussion, we performed a robotic-laparoscopic assisted debulking, with en-­ bloc resection of the external iliac vein, internal iliac compartment, obturator nerve, partial sacral plexus fibers, and partial pelvic muscles and periosteum pelvic bones. Complete removal of macroscopic disease was achieved. No intraopera- tive or post-­ operative complications were observed. Adjuvant chemotherapy was administered. Salvage surgery for selected isolated endometrial cancer recurrence with a robotic approach may be a valid alterna- tive for a complete debulking procedure. The robotic approach represents a technological advance over traditional laparos- copy, allowing radical surgery even in complex cases of recur- rence involving the pelvic side wall.4 Robotic surgery could be offered in highly selected patients with endometrial cancer recurrence (anticipated resectable peritoneal and lymphnode disease) in referral oncological centers