Robotic-Assisted Cytoreductive Surgery for Recurrent Endometrial Carcinoma with Iliac Vessel Involvement: A Multidisciplinary Approach.

Abstract

INTRODUCTION: Recurrent endometrial carcinoma involving major pelvic vasculature poses significant surgical challenges, particularly when residual disease persists after systemic therapy and radiation is contraindicated. Robotic-assisted surgery offers a minimally invasive solution for precise tumor dissection near critical vessels. CASE REPORT: A 67-year-old woman with recurrent endometrial carcinoma presented with deep vein thrombosis and pulmonary embolism 3 years after primary treatment with hysterectomy, chemotherapy, and brachytherapy. Imaging revealed a 5-cm pelvic mass encasing the right external iliac vessels and two lung nodules. After six cycles of carboplatin and liposomal doxorubicin, lung lesions resolved, but the pelvic mass persisted. OPERATIVE TECHNIQUE: A multidisciplinary team, including gynecologic oncologists and vascular surgeons, performed a robotic-assisted secondary cytoreductive surgery. A prophylactic iliac vein balloon was placed by the vascular team but remained uninflated. The procedure involved adhesiolysis, retroperitoneal dissection, and careful tumor separation from the external and internal iliac vessels with vascular preservation. Metal clips were applied to guide postoperative radiation planning. The tumor was completely resected without vascular injury. The patient recovered uneventfully and was discharged on postoperative Day 1. CONCLUSIONS: This case underscores the feasibility and safety of a multidisciplinary robotic-assisted approach for pelvic tumor resection involving major vasculature. Preoperative vascular planning and endovascular readiness enhance surgical safety, while minimally invasive techniques offer improved recovery and precision in managing recurrent endometrial carcinoma.