Robotic-assisted laparoscopic splenectomy for recurrent ovarian cancer.

Purpose: Recurrent ovarian cancer frequently involves the spleen. Our aims were to describe the technique of robotic-assisted laparoscopic splenectomy and to evaluate outcomes including progression-free and overall survival in patients who underwent this procedure for recurrent ovarian cancer.
Methods: Chart reviews were performed on all consecutive patients who underwent robotic splenectomy (April 2012 to May 2019) for recurrent ovarian cancer. Patients had ≤3 sites of disease and no ascites. Extent of disease was confirmed by positron emission tomography-computed tomography (PET-CT) pre-operatively and platinum-doublet chemotherapy was initiated post-operatively. Peri- and post-operative outcomes, progression-free survival, and overall survival were assessed. Two video links are included to demonstrate variations in technique and anatomy.
Results: A total of 10 patients were included. The median age was 63.5 years (range 46-74) and median body mass index was 30 kg/m ² (range 21.5-40.1). Disease was limited to the spleen in seven patients and three had evidence of up to two other sites of disease on imaging. The median robotic splenectomy operative time was 159 min (range 112-214) that included laparoscopic lysis of adhesions prior to robotic port placement in seven cases, and excision of diaphragm or omental implants in three cases. There were no transfusions, laparotomy conversions, return to the operating room, abscesses, or pancreatic pseudocysts. The median length of stay was 2 days (range 1-4). The median time to resumption of chemotherapy was 40 days (range 25-78). After a median follow-up of 51 months (range 12-98), five patients had recurrence (two deaths, three alive with disease), with a median time to recurrence of 14 months (range 12-15). The median progression-free survival was 15 months (range 12-98) and the median overall survival was 51 months (range 12-98) post-splenectomy.
Conclusions: Robotic splenectomy was feasible, achieving complete cytoreduction of splenic recurrent ovarian cancer, short hospital length-of-stay, and acceptable morbidity.
Competing Interests: Competing interests: RWH received compensation for advanced training programs from Intuitive Surgical, Inc (Sunnyvale, CA) and speaking honoraria from Bard-Davol (Warwick, RI) during the time these surgeries occurred.
(© IGCS and ESGO 2020. No commercial re-use. See rights and permissions. Published by BMJ.)