CASE REPORT article
Front. Oncol.
Sec. Gynecological Oncology
This article is part of the Research TopicAdvancing Surgical Outcomes for Retroperitoneal TumorsView all 13 articles
Case Report: Multidisciplinary approach for complete resection of primary advanced low-grade serous ovarian carcinoma involving the iliac vessels and paraspinal region
Provisionally accepted
NAOYUKI IDA1,2,3*
Shoji Nagao1,2,3*Atsushi Fujikawa1,2,3Yui Tanaka1,2,3Momoko Tanioka1,2,3Ryoko Imatani1,2,3Yoshinori Tani1,2,3Hanako Sugihara1,2,3Hirofumi Matsuoka1,2,3Kazuhiro Okamoto1,2,3Junko Haraga1,2,3Chikako Ogawa1,2,3Keiichiro Nakamura1,2,3Hisashi Masuyama1,2,3- 1Department of Obstetrics and Gynecology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
- 2Okayama Daigaku, Okayama, Japan
- 3Okayama Daigaku Byoin, Okayama, Japan
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Background: 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. Case Presentation: 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. Discussion: 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. Conclusion: Multidisciplinary collaboration can overcome traditional surgical and oncologic barriers, achieving both radicality and quality-of-life preservation in advanced LGSC.
Keywords: Anterolateral thigh flap, extra-pelvic invasion, gynecologic oncology, low-grade serous ovarian carcinoma, Multidisciplinary surgery, surgical limit
Received: 06 Dec 2025; Accepted: 06 Feb 2026.
Copyright: © 2026 IDA, Nagao, Fujikawa, Tanaka, Tanioka, Imatani, Tani, Sugihara, Matsuoka, Okamoto, Haraga, Ogawa, Nakamura and Masuyama. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence:
NAOYUKI IDA
Shoji Nagao
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