Robotic Assisted Secondary CytoreductionIn Case of Carcinoma Ovary

Introduction: High-grade serous carcinoma (HGSC) of the ovary is the most aggressive epithelial ovarian cancer, often diagnosed at advanced stages. Despite optimal cytoreduction and platinum- based chemotherapy, recurrence is observed in nearly 70% of patients. Secondary cytoreductive surgery (SCS) improves outcomes in selected patients with platinum-sensitive relapse, particularly when complete cytoreduction is achievable. Minimally invasive approaches, especially robotic- assisted surgery, are increasingly utilized owing to advantages in precision, visualization, and recovery. Objective: The anatomical complexity of SCS, due to adhesions and recurrent disease distribution, can be addressed with the enhanced dexterity and three-dimensional vision provided by robotic platforms, potentially improving surgical outcomes with reduced morbidity. Case History & Management: We report the case of a 52-year-old postmenopausal woman with chronic liver disease and hypertension, previously treated with laparoscopic hysterectomy and bilateral salpingo- oophorectomy for HGSC, followed by six cycles of paclitaxel-carboplatin chemotherapy. Interval cytoreductive surgery with HIPEC was performed at our center in August 2024 for residual disease. After a nine-month disease-free interval, surveillance imaging revealed a pelvic cystic lesion suspicious for recurrence. Initial aspiration was negative, but subsequent MRI confirmed solid enhancing components. She was planned for robotic-assisted SCS. Intraoperatively, following adhesiolysis, a vascular mass infiltrating the rectum was identified. The gastrointestinal team performed a robotic-assisted lower anterior resection with transverse colostomy. Complete excision was achieved, and the patient had an enhanced postoperative recovery. Conclusion: Robotic-assisted surgery is a feasible and effective option for secondary cytoreduction in recurrent ovarian carcinoma, enabling complete resection with improved recovery in carefully selected patients.