# Case Report: Multidisciplinary approach for complete resection of primary advanced low-grade serous ovarian carcinoma involving the iliac vessels and paraspinal region

## TL;DR

A 62-year-old woman with advanced low-grade serous ovarian cancer underwent a complex multidisciplinary surgery, achieving complete tumor removal and long-term disease-free survival.

## Contribution

The paper introduces the 'Four Surgical Limits' framework to guide complex surgical decision-making in advanced ovarian cancer.

## Key findings

- Complete resection (R0) was achieved through a multidisciplinary surgical approach.
- The patient remained disease-free for 13 months post-surgery.
- The proposed framework emphasizes anatomical, oncological, functional, and interdisciplinary considerations.

## Abstract

Low-grade serous ovarian carcinoma (LGSC) is characterized by indolent progression and relative resistance to cytotoxic chemotherapy, making complete cytoreduction the key prognostic determinant. However, extra-pelvic invasion presents significant surgical and functional challenges requiring coordinated multidisciplinary management.

A 62-year-old woman with FIGO stage IVB LGSC presented with right inguinal swelling infiltrating the femoral vein and abdominal wall. MRI and PET-CT revealed bilateral ovarian tumors and multiple lymph node metastases. A multidisciplinary operation involving gynecologic, orthopedic, plastic, and gastrointestinal surgeons was conducted. The procedures included total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, pelvic and para-aortic lymphadenectomy, en bloc resection of the right inguinal lesion, femoral vein repair, and anterolateral thigh flap reconstruction. Complete resection (R0) was achieved. Postoperative recovery was favorable, with transient leg edema resolving within 4 months. The patient remains disease-free at 13 months after surgery.

Strategic multidisciplinary collaboration enabled complete resection and functional preservation in this chemotherapy-resistant LGSC case. We propose the “Four Surgical Limits” framework—anatomical, oncological, functional, and interdisciplinary—as a structured concept guiding operative decision-making beyond conventional boundaries.

Multidisciplinary collaboration can overcome traditional surgical and oncologic barriers, achieving both radicality and quality-of-life preservation in advanced LGSC.