Step-by-step demonstration of laparoscopic laterally extended endopelvic resection for a recurrent endometrial cancerous tumor at a sciatic foramen, with a detailed explanation of the pelvic sidewall anatomy

Objective: Laterally extended endopelvic resection (LEER) is regarded as a surgical salvage therapy for patients with laterally recurrent gynecologic carcinomas [1]. A prerequisite for R0 resection using this excision technique is carcinoma location remote from the sciatic foramen [1,2]. However, considering the advantages provided by laparoscopy in terms of visualization and dissection, laparoscopic LEER can potentially be used to achieve R0 resection of a laterally recurrent carcinoma at the sciatic foramen [3].

Methods: The patient underwent an abdominal radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection due to stage II endometrial carcinoma. Almost 30 years later, a recurrent endometrial carcinoma, diagnosed by needle biopsy, was detected at the pelvic sidewall. Abdominal CT scan revealed that the recurrent tumor involved the bladder, right ureter, and rectum, and was located at the right sciatic foramen. Due to a long recurrence-free interval, resection surgery was chosen as the treatment.

Results: Tumor resection (LEER) and reconstructive surgery were performed laparoscopically. The operation time was 540 minutes, and blood loss volume was 350 ml, with no blood transfusion. R0 resection was achieved without any intraoperative and postoperative complications. There has been no sign of recurrence during the 6 months that have passed since this surgery.

Conclusions: Total laparoscopic LEER and reconstructive surgery for a recurrent endometrial carcinoma located at the right sciatic foramen is technically feasible in experienced hands.