Non-anatomical liver resection using Kelly clamp-crush technique during interval cytoreduction

Ovarian cancer is frequently diagnosed at an advanced stage, with liver metastases commonly observed, adversely affecting prognosis. Achieving complete cytoreduction (R0) is essential for improving overall survival in advanced ovarian cancer. Liver resections, particularly for isolated and resectable lesions, have demonstrated survival benefits. Non-anatomical resections, while preserving functional liver parenchyma, are increasingly employed in this context. This study showcases a surgical video illustrating a non-anatomical wedge liver resection performed for oligometastatic disease as part of interval cytoreductive surgery in advanced-stage ovarian cancer. A young multiparous woman in her 30 s with high-grade serous carcinoma of the right ovary and multiple hepatic metastases at diagnosis had a persistent dominant residual liver lesion following neoadjuvant chemotherapy. She had undergone prior right salpingo-oophorectomy. Interval cytoreductive surgery included peritoneal wash for cytology, hysterectomy with excision of left tube and ovary, retroperitoneal lymph node sampling, total omentectomy, peritoneal deposit excision, and non-anatomical liver resection. The surgical peritoneal cancer index was 7. Intra-operative ultrasound guided localization of a 2.5×2 cm intraparenchymal lesion in liver segments IVB/V. Wedge resection with adequate margins was performed using the Kelly clamp-crush technique, LigaSure, and monopolar cautery after ligation of the distal middle hepatic vein. The postoperative recovery proceeded without complications. Metastatic carcinoma in the liver lesion and peritoneal deposit, with no residual disease in other specimens were reported from histology. The patient received three cycles of adjuvant chemotherapy and remains disease-free at 18 months of follow-up. Non-anatomical liver resections are feasible and safe in advanced ovarian cancer with resectable oligometastatic hepatic disease and should be integrated into cytoreductive surgery when indicated. While recent evidence supports the safety and survival benefits of liver resections, additional research is needed to clarify their prognostic significance in advanced ovarian cancer.