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Introduction/Background Ovarian cancer is usually diagnosed in advanced stage. The goal of primary debulking is to achieve no residual disease (RD). Proper selection of candidates for complete debulking is crucial for the avoidance of suboptimal laparotomies. The aim of this study is to compare ‘Fagotti’ diagnostic laparoscopy and preoperative ‘Suidan’ criteria (age, ASA score, CA125, CT results) in the selection of patients for primary debulking. Methodology We retrospectively reviewed the medical records of patients with advanced ovarian cancer that underwent ‘Fagotti’ diagnostic laparoscopy (January 2017 - January 2019) in our clinic. Results 25 patients with advanced ovarian cancer underwent ‘Fagotti’ diagnostic laparoscopy, in order to decide their treatment plan. 7 patients were excluded from the study, because they did not meet the inclusion criteria. According to the preoperative predictive score, half of the patients (n=9) were assigned for primary debulking (PDS) (Group A) and the other half (n=9) for neoadjuvant chemotherapy (NACT) followed by interval debulking (IDS) (Group B). After ‘Fagotti’ diagnostic laparoscopy, the treatment plan changed in a total of 9 patients: 4 from Group A (from PDS to NACT+IDS) and 5 from Group B (from NACT+IDS to PDS), but with no statistically significant difference. From all patients (n=16) that underwent PDS or IDS, no case of suboptimal cytoreduction was documented (13 RD=0 and 3 RD Conclusion ‘Fagotti’ diagnostic laparoscopy continues to be the method of choice for the proper selection of patients for primary debulking, despite being an invasive technique. Disclosure Nothing to disclose

Introduction/Background Adenomyosis often co-exist in the pathological reports, after surgery for endometrial cancer. The aim of this study is to describe the clinicopathological and oncological characteristics of these patients and further investigate the malignant transformation of the adenomyotic tissue. Methodology We retrospectively reviewed the medical records of all patients that underwent hysterectomy for endometrial cancer (January 2012 - December 2017) in our clinic. The pathological reports were reviewed and when adenomyosis co-existed, the pathological slides were re-examined in order to discover any malignant change in the adenomyotic tissue. The clinicopathological characteristics and oncological results were described. Results Out of 229 cases of endometrial cancer, 64 (28%) patients had concurrently endometrial cancer and adenomyosis. Among these 64 patients, 7 (11%) had malignant transformation of adenomyosis. The mean age of patients suffering from both endometrial cancer and adenomyosis was 63.2 years old and 57 (89%) of these patients, had early endometrial cancer (FIGO stage IA–IB). Out of these patients, 22 (34.4%) had grade I, 36 (56.2%) grade II and only 6 (9.4%) had grade III tumors. Moreover, in this special group of patients with concurrent endometrial cancer and adenomyosis, 25 (39%) patients presented in the pathological report fibroids and 2 (3%) endometriosis. Concerning the patients with malignant transformation of adenomyosis, their mean age was 65 years old with no premenopausal case. There was only 1 case of recurrence and none death due to cancer. Conclusion Adenomyosis, as a benign disease, is described in the last decades, but its malignant transformation is not fully researched, due to the low incidence of this entity and the relative diagnostic problems. Further investigation is needed in order to clarify the pathologic progression of adenomyotic lesions to endometrial cancer and the associated prognosis of this disease. Disclosure Nothing to disclose.

Introduction/Background In ovarian cancer, metastatic cardiophrenic lymph nodes are associated with FIGO stage IV disease. The goal of debulking surgery should be no residual disease and resection of those lymph nodes is mandatory. The aim of this case report is to present the subxiphoid approach, as an alternative for the exploration of both cardiophrenic spaces from one incision, in contrast to the transdiaphragmatic approach. Methodology The patient was a 45 years old female. Preoperative work-up revealed an elevated CA-125 of 2521 and a CT-scan showing a pelvic mass, ascites, omental cake, diaphragmatic disease and enlarged supradiaphragmatic cardiophrenic lymph nodes, without pleural effusion. The patient underwent primary debulking surgery. Cytoreduction included type II radical oophorectomy (en bloc modified radical abdominal hysterectomy, bilateral salpingo-oophorectomy, pan-pelvic peritonectomy, rectosigmoid colectomy), appendicectomy, cholecystectomy, radical omentectomy, paracolic gutters peritonectomy, small - large bowel mesentery electro-coagulation, right diaphragm full-thickness resection and subxiphoid resection of supradiaphragmatic cardiophrenic lymph nodes. Results The cardiophrenic incision surgical steps included: subxiphoid peritoneal dissection, cutting of the transverse abdominis muscle, dissection of the retrosternal peritoneum laterally from the midline, digital development of the cardiophrenic space and removal of the enlarged lymph nodes. Total operative time was 450 min and estimated blood loss 700 ml, with no residual disease. Post-operative intensive care unit (ICU) admission was necessary for three days due to mild hemodynamic instability and the patient was discharged from hospital on the 17th postoperative day. The pathological report showed a grade III serous adenocarcinoma, with metastases to six of seven resected cardiophrenic lymph nodes. Conclusion Subxiphoid resection of supradiaphragmatic cardiophrenic lymph nodes is a feasible alternative approach for the exploration of both cardiophrenic spaces with no direct diaphragmatic trauma. Disclosure Nothing to disclose.

Introduction/Background Lymphocyst is rare disease,and mainly reported in some case reports.Occurrence of lymphocyst has been described in relation to surgery in a wide variety of other areas including the mediastinum, axila, neck, aorta and peripheral vasculature.The pathophysiology is based in insufficient lymphatic stasis with gross postoperative lymph leakage which cannot be absorbed in the peritoneum. Methodology A 46-year-old woman, was admitted to the emergency department, with abdominal pain. The pain was located to the abdomen.Her vital signs were non-reassuring.A mass was palpated arising from the pelvis on the left side.Her medical history included aleft oophorectomy due to a cyst form about 13 centimeters. The tumor makers were within normal range. Moreover, an abdominal MRI scan was carried out, that described the presence of a cyst measured 10 x 8 cm in the left parametrium.She was scheduled for surgery a few days later. The cyst was above the division of iliac vessels cling to left ureter and left uterine artery. The operation was uncomplicated and her post-operative period was uneventful. Histology showed lymphocyst, without any signs of malignancy Fifteen days later after a routine check, an entrenched retention of fluid was found in the pouch of Douglas 5 cm which was aspirated by needle under guidance of Computed Tomografy. The cytological examination showed lymphpocytes as an inflammatory response. Results In 5 to 10% of patients, the lymphocyst become symptomatic, manifesting fever, pain, constipation, prolonged ileus, urinary frequency, obstructive uropathy, leg edema, erythema of overlying skin or deep vein thrombosis. Conclusion Most lymphocysts are asymptomatic and are only diagnosed accidentally. A symptomatic lymphocyst may compress adjacent structures, for example, ureter, the urinary bladder, rectum or the iliac vein. Pelvic lymphocysts may be treated conservatively or surgically, by laparoscopy or laparotomy as well as using the methods of intervention radiology. Disclosure Nothing to disclose

Introduction/Background Ovarian cancer is usually diagnosed in advanced stage. The goal of debulking surgery should be no residual disease. This may lead to severe postoperative complications, prolonging hospital stay and delaying chemotherapy initiation. The aim of this study is to identify possible predictive factors and minimize the occurrence of postoperative complications. Methodology We retrospectively reviewed the medical records of all patients that underwent primary (PDS) or interval (IDS) debulking surgery for advanced epithelial ovarian cancer (January 2018–December 2018) in two medical clinics. The clinicopathological characteristics, oncological and surgical results were described. Results Out of total 79 patients with ovarian cancer, 49 met the eligibility criteria. The mean age was 61±12 years old and the majority of them, 44 (90%), had FIGO stage III serous adenocarcinoma. The median hospitalization was 8±3 days and the postoperative complications ranged from 0 to 100, with one death within 30days. A univariate analysis was conducted: There was a statistically significant difference (p-value=0.002) between primary and interval debulking surgery: PDS showed increased postoperative complications. Furthermore, Aletti score, prolonged surgery duration (>300 min), elevated preoperative CA-125 and postoperative intensive care unit (ICU) admission were statistically significant associated with increased postoperative complications (p-value Conclusion Aletti score, prolonged surgery duration, elevated CA-125, postoperative ICU admission and primary debulking surgery were statistically significant associated with more postoperative complications.‘Fagotti’ diagnostic laparoscopy could be a possible way to decrease postoperative complication but further investigation with more patients is needed. Disclosure Nothing to disclose.