Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer
Section snippets
Background
Women with suspected advanced epithelial ovarian cancer (EOC) should be evaluated by a gynecologic oncologist to determine the appropriate initial treatment modality [1]. This evaluation usually includes imaging of the chest, abdomen, and pelvis, to determine the extent of disease and the feasibility of optimal surgical resection [1], [2]. A 2001 survey of gynecologic oncologists revealed that the presence of upper abdominal disease and/or disease in “hazardous locations” were the most common
Methods
After Institutional Review Board approval, we identified patients with Stage IIIB-IV ovarian cancer who underwent primary CRS for high-grade EOC at our institution (Memorial Sloan Kettering Cancer Center) from January 2001 to December 2013. Patients were included if they had undergone a supradiaphragmatic resection with the intent of removing one or more CPLN(s) for diagnosis and/or treatment of ovarian cancer. Patients were excluded if they received neoadjuvant chemotherapy (NACT). Patients
Results
Of the 985 patients at our institution who underwent primary CRS for Stage IIIB-IV high-grade EOC from January 2001 to December 2013, we identified 54 patients who underwent surgical resection of the CPLN(s). The median age in this group was 59 years (range 41–74). In all 54 cases, enlarged or suspicious CPLNs were documented on preoperative CT reports. The median diameter of an enlarged CPLN was 1.3 cm (range 0.6–2.9). Preoperative pleural effusion was noted in 13 (24%) patients. Peritoneal
Discussion
While there is ongoing debate about whether NACT or CRS constitutes the best treatment approach for advanced EOC in the primary setting, we believe that a combination surgical/systemic therapeutic intervention provides the best opportunity for potential cure of this disease. At our institution we offer CRS as primary treatment to medically fit patients with resectable disease, at the time of diagnosis. Data have shown that CRS resulting in minimal (< 1 cm) or microscopic residual disease
Conflict of interest statement
None of the authors declare any conflicts of interest.
Dr. Chi serves on the Medical Advisory Board of Bovie Medical Corporation, and on the Medical Advisory Board of Verthermia. He has no conflicts of interest pertinent to this work.
Funding support
This study was funded in part through the NIH/NCI Support Grant P30 CA008748.
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Do PET-positive supradiaphragmatic lymph nodes predict overall survival or the success of primary surgery in patients with advanced ovarian cancer?
2024, European Journal of Obstetrics and Gynecology and Reproductive BiologyResponse to treatment and prognostic significance of supradiaphragmatic disease in patients with high-grade serous ovarian cancer
2022, European Journal of Surgical OncologyWhat are the implications of radiologically abnormal cardiophrenic lymph nodes in advanced ovarian cancer? An analysis of tumour burden, surgical complexity, same-site recurrence and overall survival
2022, European Journal of Surgical OncologyCitation Excerpt :In the context of radiologically positive CPLNs, the literature reports that the finite number of suspicious nodes does not independently impact on patient outcome [18]. Whilst we, and other recent studies, applied a discriminatory LN diameter of 5 mm to align with ESUR guidance (2010) – the radiological cut-off for the identification of CPLN positivity in EOC is yet to be standardised [23,28–33]. Other evaluators have instead opted to adhere to RECIST guidance (2009), setting the measurement threshold at 10 mm [12,34,35].
Right upper quadrant cytoreductive procedures and cardiophrenic lymph node resection in primary debulkig surgery for ovarian cancer
2021, Gynecologic Oncology ReportsPostoperative chest liver herniation after cardiophrenic lymph node resection by a transdiaphragmatic approach following primary cytoreductive surgery for advanced endometrioid ovarian cancer: A case report
2021, Gynecologic Oncology ReportsCitation Excerpt :The low serologic level of albumin of this patient (20 g/l for a normal standardized value of 30 g/l) may be considered as a factor contributing to this complication. CPLN resection is a feasible procedure with low morbidity and low rates of postoperative complications, being the pleural effusion the most frequent (Cowan et al., 2017). Chylothorax is an infrequent complication with a rate of mortality around 10%, mainly observed in medical disorders such as infectious diseases or thoracic duct obstruction due to mediastinal malignancies and also in patients undergoing thoracic surgery (Shah et al., 2012).