Enlarged pelvic and abdominal lymph nodes often invade major blood vessels, nerves, and ureters. Resection of these nodes may result in surgical failure due to rupture, tumor fluid leakage or damage to large blood vessels. This study presents a case of locally advanced cervical carcinoma as an example to explore the minimally invasive surgical technique of non-clamping whole-block excision.

A retrospective analysis was conducted on clinical data from a patient with stage ⅢC1r locally advanced squamous cervical cancer who underwent staged surgery for para-abdominal aortic lymph node dissection and simultaneous removal of pelvic mega-lymph nodes at the Gynecological Oncology Center in Chongqing University Cancer Hospital in Jan. 2021.

The da Vinci Xi robot was used for minimally invasive surgery following the principle of sequential layer-by-layer advancement from simple to difficult (the "easy first" principle). The procedure employed the "tunnel principle" to carefully separate lymph nodes using a combination of blunt and sharp techniques while ensuring protection of blood vessels and preserving lymph node integrity. Advanced surgical tools were strategically used for precise removal of pelvic giant lymph nodes and para-aortic lymph nodes as a single unit. Intraoperative bleeding was minimal without any complications. Surgical pathology revealed stage ⅢC2p cervical squamous carcinoma. Concurrent chemoradiotherapy started 13 days after surgery and was successfully completed within 60 days with mild grade I gastrointestinal reaction and neutropenia observed as treatment side effects. After treatment, complete response (CR) was achieved with no recurrence during the two-year follow-up period.

The non-clamping whole-block excision technique provides a secure and feasible approach for the removal of locally advanced cervical cancer with pelvic and abdominal lymph node enlargement. This method effectively mitigates tumor dissemination resulting from lymph node damage, reduces tumor burden, and does not impact the timing of radiotherapy initiation.