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. 2017 Nov;147(2):262-266.
doi: 10.1016/j.ygyno.2017.09.001. Epub 2017 Sep 6.

Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer

Renee A Cowan  1 , Jill Tseng  1 , Vijayashree Murthy  1 , Radhika Srivastava  1 , Kara C Long Roche  2 , Oliver Zivanovic  2 , Ginger J Gardner  2 , Dennis S Chi  2 , Bernard J Park  3 , Yukio Sonoda  4
Affiliations

Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer

Renee A Cowan et al. Gynecol Oncol. 2017 Nov.

Abstract

Objectives: Surgical resection of enlarged cardiophrenic lymph nodes (CPLNs) in primary treatment of advanced ovarian cancer has not been widely studied. We report on a cohort of patients undergoing CPLN resection during primary cytoreductive surgery (CRS), examining its feasibility, safety, and potential impact on clinical outcomes.

Methods: We identified all patients undergoing primary CRS/CPLN resection for Stages IIIB-IV high-grade epithelial ovarian cancer at our institution from 1/2001-12/2013. Clinical and pathological data were collected. Statistical tests were performed.

Results: 54 patients underwent CPLN resection. All had enlarged CPLNs on preoperative imaging. Median diameter of an enlarged CPLN: 1.3cm (range 0.6-2.9). Median patient age: 59y (range 41-74). 48 (88.9%) underwent transdiaphragmatic resection; 6 (11.1%) underwent video-assisted thoracic surgery. A median of 3 nodes (range 1-23) were resected. A median of 2 nodes (range 0-22) were positive for metastasis. 51/54 (94.4%) had positive nodes. 51 (94.4%) had chest tube placement; median time to removal: 4d (range 2-12). 44 (81.4%) had peritoneal carcinomatosis. 19 (35%) experienced major postoperative complications; 4 of these (7%) were surgery-related. Median time to adjuvant chemotherapy: 40d (range 19-205). All patients were optimally cytoreduced, 30 (55.6%) without visible residual disease. Median progression-free survival: 17.2mos (95% CI 12.6-21.8); median overall survival: 70.1mos (95% CI 51.2-89.0).

Conclusions: Enlarged CPLNs can be identified on preoperative imaging and may indicate metastases. Resection can identify extra-abdominal disease, confirm Stage IV disease, obtain optimal cytoreduction. In the proper setting it is feasible, safe, and does not delay chemotherapy. In select patients, it may improve survival.

Keywords: Cardiophrenic lymph nodes; Optimal tumor debulking; Ovarian cancer; Paracardiac lymph nodes; Primary cytoreductive surgery; Radical surgery; Supradiaphragmatic lymph nodes.

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Conflict of interest statement

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.

Figures

Figure 1:
Figure 1:
Survival by Residual Disease Status Overall survival by status of residual disease Complete gross resection [CGR] and optimal debulking [Opt]
See this image and copyright information in PMC

References

    1. Wright AA, Bohlke K, Armstrong DK, Bookman MA, Cliby WA, Coleman RL, et al. Neoadjuvant Chemotherapy for Newly Diagnosed, Advanced Ovarian Cancer: Society of Gynecologic Oncology and American Society of Clinical Oncology Clinical Practice Guideline. J Clin Oncol 2016;34:3460–73. - PMC - PubMed
    1. Suidan RS, Ramirez PT, Sarasohn DM, Teitcher JB, Mironov S, Iyer RB, et al. A multicenter prospective trial evaluating the ability of preoperative computed tomography scan and serum CA-125 to predict suboptimal cytoreduction at primary debulking surgery for advanced ovarian, fallopian tube, and peritoneal cancer. Gynecol Oncol 2014;134:455–61. - PMC - PubMed
    1. Eisenkop SM, Spirtos NM. What are the current surgical objectives, strategies, and technical capabilities of gynecologic oncologists treating advanced epithelial ovarian cancer? Gynecol Oncol 2001;82:489–97. - PubMed
    1. Eisenhauer EL, Abu-Rustum NR, Sonoda Y, Levine DA, Poynor EA, Aghajanian C, et al. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol Oncol 2006;103:1083–90. - PubMed
    1. Hoffman MS, Tebes SJ, Sayer RA, Lockhart J. Extended cytoreduction of intraabdominal metastatic ovarian cancer in the left upper quadrant utilizing en bloc resection. Am J Obstet Gynecol 2007;197:209 e1–5. - PubMed

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