1
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Wu Q, Huo Y, Zhang F, Gao F, Wu J, Chen L. Management of chylothorax after retrocrural lymphadectomy in a patient with ovarian cancer: a case report. Ann Med Surg (Lond) 2024; 86:3658-3662. [PMID: 38846813 PMCID: PMC11152812 DOI: 10.1097/ms9.0000000000002037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/29/2024] [Indexed: 06/09/2024] Open
Abstract
Introduction and importance With the widespread use of positron emission tomography and computed tomography (PET/CT), a significantly greater proportion of patients with advanced ovarian cancer (OC) are now diagnosed with superior renal-vein lymph node metastases involving retrocrural and mediastinal nodes. To the authors' knowledge, retrocrural lymphadenectomy has not yet been reported in patients with OC. The authors performed retrocrural lymph node resection in a patient with ovarian cancer. Case presentation A 64-year-old woman with ovarian cancer who had not undergone surgery upon initial diagnosis was admitted to the authors' hospital because tumour markers increased during bevacizumab maintenance therapy. PET/CT imaging revealed adnexal masses and multiple metastases in pelvic, para-aortic, retrocrural, and mediastinal lymph nodes. Reduction surgery was performed, and retrocrural lymph nodes were excised. However, the patient's postoperative course was complicated by a chylothorax. Because of the failure of conservative treatment, interventional embolization was performed, but failed to obstruct lymphatic vessels. The patient underwent reoperation. A fistula was located where Hem-o-lock clips penetrated the pleura, clearly indicating the injury site, which was then sutured and embedded in the surrounding diaphragmatic tissue and filled with gel sponge. The patient recovered from chylous leakage postoperatively. She later underwent chemotherapy and targeted maintenance therapy. Clinical discussion The authors may have injured the communicating branch of the thoracic duct posterior to the diaphragm during the first operation and did not ligate it. The accumulated chylous fluid finally penetrated through the weak point on the pleura and led to chylothorax 3 days later. If conservative treatment or interventional embolization are unsuccessful, surgical treatment should be selected in time. Conclusion The location of the retrocrural lymph node at the anastomosis of the chylous cistern and the thoracic duct may pose a significant risk of chylous leakage as a complication of lymphadenectomy. Full exposure of the surgical field and thorough ligation of the lymphatic vessels may lead to successful superior renal-vein lymphadenectomy.
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Affiliation(s)
- Qingyun Wu
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute
| | - Yanqin Huo
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute
| | - Fang Zhang
- Department of Radiology, Shandong Provincial Hospital, Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, P.R. China
| | - Fufeng Gao
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute
| | - Jianlei Wu
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute
| | - Liang Chen
- Department of Gynecological Oncology, Shandong Cancer Hospital and Institute
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Kahn RM, Chang SJ, Chi DS. Extra-abdominal cytoreductive techniques in ovarian cancer: how far can (should) we go? Int J Gynecol Cancer 2024; 34:379-385. [PMID: 38438179 DOI: 10.1136/ijgc-2023-004630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2024] Open
Abstract
Complex surgery is an essential component in the management of advanced ovarian cancer. Furthermore, achieving complete gross resection in cytoreductive surgery appears to be associated with significant survival benefits in patients with advanced ovarian cancer. The goal of this review is to demonstrate the advancement of surgical techniques in gynecologic oncology surgery, including resection of disease within the intrathoracic and inguinal regions. This progress has expanded the option of surgery to more patients, especially those who would have previously been deemed inoperable. In this review we describe the most notable studies and reports of surgical resection of ovarian cancer involving cardiophrenic/supradiaphragmatic lymph nodes, mediastinum, lung pleura or parenchyma, and the inguinal region. We also describe the growing role that video-assisted thoracic surgery has played in advanced ovarian cancer diagnosis and management. The studies, series, and reports described demonstrate that comprehensive surgical procedures outside of the abdomen or pelvis can be both safe and feasible in properly selected patients. They also suggest that resection of disease outside of the abdomen or pelvis may benefit appropriately selected patients. Future studies are necessary to identify which patients may benefit most from upfront surgery versus neoadjuvant chemotherapy when ovarian cancer metastasis is present in the thoracic or inguinal regions.
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Affiliation(s)
- Ryan M Kahn
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Suk-Joon Chang
- Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea (the Republic of)
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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3
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Wang J, Wang X, Yin W, Zhang S. Survival impact and safety of intrathoracic and abdominopelvic cytoreductive surgery in advanced ovarian cancer: a systematic review and meta-analysis. Front Oncol 2024; 14:1335883. [PMID: 38304874 PMCID: PMC10830636 DOI: 10.3389/fonc.2024.1335883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 01/02/2024] [Indexed: 02/03/2024] Open
Abstract
Purpose Achieving no residual disease is essential for increasing overall survival (OS) and progression-free survival (PFS) in ovarian cancer patients. However, the survival benefit of achieving no residual disease during both intrathoracic and abdominopelvic cytoreductive surgery is still unclear. This meta-analysis aimed to assess the survival benefit and safety of intrathoracic and abdominopelvic cytoreductive surgery in advanced ovarian cancer patients. Methods We systematically searched for studies in online databases, including PubMed, Embase, and Web of Science. We used Q statistics and I-squared statistics to evaluate heterogeneity, sensitivity analysis to test the origin of heterogeneity, and Egger's and Begg's tests to evaluate publication bias. Results We included 4 retrospective cohort studies, including 490 patients, for analysis; these studies were assessed as high-quality studies. The combined hazard ratio (HR) with 95% confidence interval (CI) for OS was 1.92 (95% CI 1.38-2.68), while the combined HR for PFS was 1.91 (95% CI 1.47-2.49). Only 19 patients in the four studies reported major complications, and 4 of these complications were surgery related. Conclusion The maximal extent of cytoreduction in the intrathoracic and abdominopelvic tract improves survival outcomes, including OS and PFS, in advanced ovarian cancer patients with acceptable complications. Systematic Review Registration PROSPERO, identifier CRD42023468096.
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Affiliation(s)
- Jiaxi Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Xingyu Wang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Wanjun Yin
- Weifang Medical University, Weifang, China
| | - Shiqian Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
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Huo Y, Wu Q, Zhang F, Gao F, Wu J, Chen L. Chylothorax after Retrocrural Lymphadectomy and Consideration of Ultraradical Surgery in Ovarian Cancer: A case report.. [DOI: 10.21203/rs.3.rs-2960465/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/28/2023]
Abstract
Abstract
Purpose:
Retrocrural lymph node resection has not yet been reported in patients with ovarian cancer. We tried to do so.
Patients and Methods:
This report presents one ovarian cancer patient, complicated by multiple distant lymph node metastases in PET/CT imaging. Ovarian cancer reduction surgery was performed, and retrocrural lymph nodes were removed. However, the patient developed a chylothorax after surgery. Thoracotomy was performed after failed interventional therapy and a clear leakage point was identified. Subsequently, the peripheral diaphragm was sutured and filled with gel sponge.
Results:
The chylothorax was cured, and the patient continues to receive chemotherapy.
Conclusions:
There is a critical need to identify an effective approach to perform systemic R0 surgery with fewer complications.
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Affiliation(s)
- Yanqin Huo
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
| | - Qingyun Wu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
| | - Fang Zhang
- Shandong Provincial Hospital, Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
| | - Fufeng Gao
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
| | - Jianlei Wu
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
| | - Liang Chen
- Shandong Cancer Hospital and Institute, Shandong First Medical University, Shandong Academy of Medical Sciences
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5
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Song S, Chen H, Ning G, Guo Y, Li X. Clinical significance of enlarged cardiophrenic lymph nodes by CT in advanced ovarian cancer. Front Oncol 2023; 13:1149139. [PMID: 37007136 PMCID: PMC10063917 DOI: 10.3389/fonc.2023.1149139] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Accepted: 03/08/2023] [Indexed: 03/19/2023] Open
Abstract
AimThis study aims to assess the clinical influence of enlarged cardiophrenic lymph nodes (CPLN) on staging computed tomography (CT) among patients with advanced ovarian cancer.MethodsThis retrospective cohort study included 320 patients with advanced epithelial ovarian cancer who underwent staging CT from May 2008 to January 2019. The CPLN diameter was the average of two radiologists’ measurements. Enlarged CPLN was defined as a short-axis diameter of ≥5 mm. Clinical and imaging findings, management decisions, and progression-free survival(PFS) were compared between patients with and without enlarged CPLN.ResultsEnlarged CPLN was found in 129 (40.3%) patients, which was significantly associated with more pelvic peritoneal carcinomatosis (odds ratio [OR]: 6.61 with 95% confidence interval [CI]: 1.51–28.99), and involved the greater omentum (OR: 6.41, 95% CI: 3.05–13.46), spleen capsule nodules (OR: 2.83, 95% CI: 1.58–5.06), and liver capsule nodules (OR: 2.55, 95% CI: 1.57–4.17). The optimal cytoreduction rates did not differ between patients with and without enlarged CPLN (p = 0.656). The presence of enlarged CPLN had a significant negative influence on PFS (median PFS, 23.5 vs. 80.6 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.023) in patients with no RD after primary debulking surgery, but no adverse effect on PFS among patients with RD (median PFS, 28.0 vs. 24.4 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.359). However, enlarged CPLN on staging CT did not affect PFS in patients treated with neoadjuvant chemotherapy, with (median PFS, 22.4 vs. 23.6 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.360) or without RD (median PFS, 17.7 vs. 23.3 months, respectively, CPLN ≥5 mm versus <5 mm; p = 0.400). The enlarged CPLN showed a decreased trend in 81.6% (n = 80) of the patients with enlarged CPLN. No significant difference was found in PFS (p = 0.562) between patients with decreased and increased in the size of CPLN.ConclusionsEnlarged CPLN on staging CT is associated with more abdominal disease but is not reliable in predicting complete resection. Enlarged CPLN awareness is necessary for patients with a primary chance of complete resection of abdominal disease.
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Affiliation(s)
- Sisi Song
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- Department of Radiology, Deyang People’s Hospital, Deyang, Sichuan, China
| | - Huizhu Chen
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Gang Ning
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
| | - Yingkun Guo
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yingkun Guo, ; Xuesheng Li,
| | - Xuesheng Li
- Department of Radiology, Key Laboratory of Birth Defects and Related Diseases of Women and Children of Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu, China
- *Correspondence: Yingkun Guo, ; Xuesheng Li,
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6
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Leone Roberti Maggiore U, Bogani G, Martinelli F, Signorelli M, Chiappa V, Lopez S, Granato V, Ditto A, Raspagliesi F. Response to treatment and prognostic significance of supradiaphragmatic disease in patients with high-grade serous ovarian cancer. EUROPEAN JOURNAL OF SURGICAL ONCOLOGY 2022; 48:2551-2557. [PMID: 36089452 DOI: 10.1016/j.ejso.2022.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/15/2022] [Accepted: 08/23/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES This study was designed to investigate the response to chemotherapy of supradiaphragmatic disease diagnosed by preoperative imaging. As secondary objectives, oncologic outcomes of patients affected by supradiaphragmatic disease and their pattern of recurrence were also evaluated. METHODS Data of consecutive patients with newly diagnosed FIGO stage IV (for supradiaphragmatic disease) epithelial ovarian cancer undergoing either primary debulking surgery or neoadjuvant chemotherapy plus interval debulking surgery between 2004 and 2021, were retrospectively collected. All patients were preoperatively evaluated by chest/abdominal CT scan or 18F-FDG PET/CT preoperatively and at follow-up to evaluate response to chemotherapy. At follow-up visits, site of recurrence diagnosed by imaging techniques was systematically recorded as it occurred. Progression-free and overall survival were measured by using Kaplan-Meier and Cox models. RESULTS A total of 130 patients was included in this study with a median (range) follow-up of 32.9 (12.8-176.7) months. Complete or partial response was achieved in most of the patients after 3 cycles (77.7%) and 6 cycles (85.4%) of chemotherapy. At follow-up, recurrence occurred in 96 (73.8%) patients and the main site of recurrence was abdomen only in 64 (66.7%) patients. At multivariate analysis, residual disease after surgery was the only variable influencing survival outcomes. CONCLUSIONS Supradiaphragmatic disease respond to chemotherapy in most patients affected by advanced EOC and recurrence mainly occurs in the abdomen. Results from this study confirms that abdominal optimal cytoreduction is the main surgical goal in the treatment of women affected by FIGO stage IV EOC.
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Affiliation(s)
| | - G Bogani
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Martinelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - M Signorelli
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Chiappa
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - S Lopez
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Granato
- Obstetric and Gynecology Unit, University of Insubria, Ospedale di Circolo Fondazione Macchi, Varese, Italy
| | - A Ditto
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - F Raspagliesi
- Gynecologic Oncology Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Miura H, Miura J, Goto S, Yamamoto T. Ovarian serous carcinoma in which mediastinal recurrence of the cancer was resected 16 years after surgery: A case report. Respirol Case Rep 2022; 10:e0988. [PMID: 35706777 PMCID: PMC9184237 DOI: 10.1002/rcr2.988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 05/23/2022] [Indexed: 11/23/2022] Open
Abstract
We report a rare case of ovarian carcinoma in which a mediastinal recurrence was resected 16 years after the initial operation. A 72‐year‐old woman underwent hysterectomy with adnexectomy for stage IIIC ovarian serous carcinoma after neoadjuvant chemotherapy. Six courses of adjuvant chemotherapy were administered. Three years after surgery, left supraclavicular lymph node metastasis occurred, and radiotherapy and two courses of chemotherapy were administered. Six years before presentation, a metastasis at the right cardiophrenic lymph node was resected, and six courses of chemotherapy were administered. During follow‐up, a retrosternal tumour was found. The metastatic lesion in contact with the diaphragm was thought to result from pleuroperitoneal communication, and it increased in size. Although high‐grade serous carcinoma is aggressive, its sensitivity to chemotherapy may suppress early recurrence, contributing to good outcomes, but with late recurrence. Multidisciplinary therapy including surgery is required for improved long‐term prognosis for mediastinal metastasis of ovarian serous carcinoma.
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Affiliation(s)
- Hiroyuki Miura
- Department of Thoracic Surgery Akiru Municipal Medical Centre Tokyo Japan
| | - Jun Miura
- Department of Surgery Kyorin University School of Medicine Tokyo Japan
| | - Shinichi Goto
- Department of Respirology Akiru Municipal Medical Centre Tokyo Japan
| | - Tomoko Yamamoto
- Department of Pathology Tokyo Women's Medical University Tokyo Japan
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8
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Sassine D, Liu C, Sonoda Y, Chi DS. Safety and Efficacy of Supradiaphragmatic Lymph Node Dissection in Advanced Ovarian Cancer. J Gynecol Surg 2022; 38:202-206. [DOI: 10.1089/gyn.2022.0030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Dib Sassine
- Gynecology Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
| | - Chrissy Liu
- Gynecology Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
| | - Yukio Sonoda
- Gynecology Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill–Cornell Medical Center, New York, NY, USA
| | - Dennis S. Chi
- Gynecology Service, Department of Surgery, Memorial Sloan–Kettering Cancer Center, New York, NY, USA
- Department of Obstetrics and Gynecology, Weill–Cornell Medical Center, New York, NY, USA
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9
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Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis. Cancers (Basel) 2021; 13:cancers13195017. [PMID: 34638501 PMCID: PMC8507882 DOI: 10.3390/cancers13195017] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/01/2021] [Accepted: 10/04/2021] [Indexed: 11/16/2022] Open
Abstract
PURPOSE To evaluate the clinical outcomes of enlarged cardiophrenic lymph node (CPLN) in advanced-stage epithelial ovarian cancer (AEOC) patients who underwent cytoreductive surgery. METHODS The Embase, Medline, Web of Science, Cochrane Library, and Google Scholar databases were searched for articles from the database inception to June 2021. Meta-analysis was conducted to determine the prognostic impact of surgical outcome, postoperative complication, and survival using random-effects models. RESULTS A total of 15 studies involving 727 patients with CPLN adenopathy and 981 patients without CPLN adenopathy were included. The mean size of preoperative CPLN was 9.1± 3.75 mm. Overall, 82 percent of the resected CPLN were histologically confirmed pathologic nodes. Surgical outcomes and perioperative complications did not differ between both groups. The median OS time was 42.7 months (95% CI 10.8-74.6) vs. 47.3 months (95% CI 23.2-71.2), in patients with and without CPLN adenopathy, respectively. At 5 years, patients with CPLN adenopathy had a significantly increased risk of disease recurrence (HR 2.14, 95% CI 1.82-2.52, p < 0.001) and dying from the disease (HR 1.74, 95% CI 1.06-2.86, p = 0.029), compared with those without CPLN adenopathy. CPLN adenopathy was significantly associated with ascites (OR 3.30, 95% CI 1.90-5.72, p < 0.001), pleural metastasis (OR 2.58, 95% CI 1.37-4.82, p = 0.003), abdominal adenopathy (OR 2.30, 95% CI 1.53-3.46, p < 0.001) and extra-abdominal metastasis (OR 2.30, 95% CI 1.61-6.67, p = 0.001). CONCLUSIONS Enlarged CPLN in preoperative imaging is highly associated with metastatic involvement. Patients with CPLN adenopathy had a lower survival rate, compared with patients without CPLN adenopathy. Further randomized controlled trials should be conducted to definitively demonstrate whether CPLN resection at the time of cytoreductive surgery is beneficial.
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10
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Turkmen O, Kilic F, Ersak B, Kimyon Comert G, Ayhan S, Ozdemir M, Turan T. Transdiaphragmatic cardiophrenic lymph node resection in a patient with an advanced-stage ovarian cancer. J OBSTET GYNAECOL 2021; 42:527-529. [PMID: 34379542 DOI: 10.1080/01443615.2021.1942440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Osman Turkmen
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Fatih Kilic
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Burak Ersak
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Gunsu Kimyon Comert
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Sevgi Ayhan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Mustafa Ozdemir
- Department of Radiology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
| | - Taner Turan
- Department of Gynecologic Oncology, Ankara City Hospital, University of Health Sciences, Ankara, Turkey
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11
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Oommen I, Chandramohan A, Raji PS, Thomas A, Joel A, Samuel Ram T, Peedicayil A. Clinical significance of CT detected enlarged cardiophrenic nodes in ovarian cancer patients. Abdom Radiol (NY) 2021; 46:331-340. [PMID: 32577780 DOI: 10.1007/s00261-020-02618-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
AIM To assess the relevance of enlarged cardiophrenic lymph nodes (CPLN) seen on staging CT of ovarian cancer patients. METHODS Retrospective cohort study of consecutive patients with primary ovarian malignancy who underwent staging CT between 2013 and 2016. Images were reviewed by two radiologists in consensus. Enlarged CPLN was defined as a short axis diameter ≥ 7 mm. Clinical and imaging findings; management decisions; outcome of cytoreductive surgery and survival were compared between patients with and without enlarged CPLN on staging CT. RESULTS Enlarged CPLN were found in 42 patients (41.5%) and was significantly associated with higher radiological PCI (p = 0.002); large volume upper abdominal disease (p = 0.001); enlarged lesser omental, periportal and supra-renal para-aortic lymph nodes (p ≤ 0.05); unfavorable sites of disease involvement (p < 0.001) and extraperitoneal metastases (p = 0.004). While there was a significant difference in the number of patients who underwent primary and interval debulking (p = 0.002), there was no difference in the rates of optimal cytoreduction between the two groups (p = 0.469). After adjusting for outcomes of cytoreductive surgery, CT detected enlarged CPLN did not adversely affect the overall survival, HR 1.5 (0.708-3.4), p = 0.272, but adversely affected the recurrence free survival (HR 2.38 (1.25-4.53)), p = 0.008. CONCLUSIONS Enlarged CPLN detected on staging CT in patients with primary ovarian cancer is clinically significant even in the developing world and is associated with higher volume of peritoneal, non-regional nodal and extraperitoneal disease and lower recurrence free survival.
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Affiliation(s)
- Indu Oommen
- Department of Radiology, Christian Medical College, Vellore, 632004, India
| | | | - P S Raji
- Department of Gynecological Oncology, Christian Medical College, Vellore, 632004, India
| | - Anitha Thomas
- Department of Gynecological Oncology, Christian Medical College, Vellore, 632004, India
| | - Anjana Joel
- Department of Medical Oncology, Christian Medical College, Vellore, 632004, India
| | - Thomas Samuel Ram
- Department of Radiation Oncology, Christian Medical College, Vellore, 632004, India
| | - Abraham Peedicayil
- Department of Gynecological Oncology, Christian Medical College, Vellore, 632004, India
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12
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Sassine D, Nasioudis D, Miller K, Chang R, Basaran D, Smith ES, Ehmann S, Chi DS. Acute pericarditis after transabdominal cardiophrenic lymph node dissection and pericardotomy during ovarian cancer debulking surgery: A case report. Gynecol Oncol Rep 2020; 35:100683. [PMID: 33364288 PMCID: PMC7750320 DOI: 10.1016/j.gore.2020.100683] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 12/03/2020] [Accepted: 12/06/2020] [Indexed: 12/12/2022] Open
Abstract
•Complete gross resection as part of debulking surgery is crucial in advanced ovarian cancer.•Supradiaphragmatic lymph node resection may prolong survival in patients with ovarian cancer.•We report acute pericarditis after supradiaphragmatic lymph node resection and pericardotomy.
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Affiliation(s)
- Dib Sassine
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dimitrios Nasioudis
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Kathryn Miller
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rebecca Chang
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Derman Basaran
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Evan S Smith
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sarah Ehmann
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Dennis S Chi
- Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Obstetrics & Gynecology, Weill Cornell Medical Center, New York, NY, USA
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13
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Role of cardiophrenic lymph node removal in advanced ovarian cancer. Int J Gynecol Cancer 2020; 31:307. [DOI: 10.1136/ijgc-2020-002207] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/10/2020] [Accepted: 11/12/2020] [Indexed: 11/03/2022] Open
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14
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Larish A, Mert I, McGree M, Weaver A, Sheedy S, Cilby W. Recurrence patterns in patients with abnormal cardiophrenic lymph nodes at ovarian cancer diagnosis. Int J Gynecol Cancer 2020; 30:504-508. [PMID: 31953350 DOI: 10.1136/ijgc-2019-000981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/19/2019] [Accepted: 12/26/2019] [Indexed: 01/19/2023] Open
Abstract
OBJECTIVES Metastases in cardiophrenic lymph nodes noted at diagnosis of epithelial ovarian cancer confer a poor prognosis. It is unclear if cardiophrenic nodal metastases portend an atypical pattern of recurrence. We report on patients with radiographically involved cardiophrenic lymph nodes who underwent optimal primary debulking surgery to describe patterns of recurrence and response to chemotherapy. METHODS Patients undergoing primary debulking surgery for stage IIIC/IV epithelial ovarian carcinoma with residual disease ≤1.0 cm at our institution from 2003 to 2011 with a pre-operative computed tomography (CT) scan were identified. Scans were reviewed by blinded radiologists, who identified abnormal cardiophrenic lymph nodes via a qualitative assessment scale based on size, heterogeneity, and architecture. RESULTS Of the 250 patients identified, a recurrence site was documented in 22/27 (81.5%) with abnormal pre-operative cardiophrenic lymph nodes (defined by an elevated Qualitative Assessment Scale (QAS) score of ≥4), and in 128/223 (57.4%) without abnormal pre-operative cardiophrenic lymph nodes. Median short axis and long axis lymph node diameters for these patients was 9 (range 6-15) mm and 15 (range 11-22) mm, respectively. Cardiophrenic lymph nodes were resected in one patient. Patients with abnormal cardiophrenic nodes are more likely to have synchronous recurrence in thorax/pelvis and abdomen (50.0% (11/22) vs 25.0% (32/128), p=0.02) and less likely to have isolated recurrence in pelvis or abdomen (40.9% (9/22) vs 68.0% (87/128)). All patients who had a CT scan after six cycles of chemotherapy had improvement (defined as reduction of QAS score) in cardiophrenic lymphadenopathy. CONCLUSIONS Despite cardiophrenic adenopathy demonstrating a complete radiographic response to chemotherapy, their presence pre-operatively is associated with an increased risk of recurrence in the thorax. Knowledge of this propensity to recur in the thorax is important to ensure all extra-abdominal recurrence sites are diagnosed and managed appropriately.
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Affiliation(s)
- Alyssa Larish
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Ismail Mert
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Michaela McGree
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Amy Weaver
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - Shannon Sheedy
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
| | - William Cilby
- Obstetrics and Gynecology, Mayo Clinic, Rochester, Minnesota, USA
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Pinelli C, Morotti M, Casarin J, Tozzi R, Alazzam M, Mavroeidis VK, Soleymani Majd H. The Feasibility of Cardiophrenic Lymphnode Assessment and Removal in Patients Requiring Diaphragmatic Resection During Interval Debulking Surgery for Ovarian Cancer. J INVEST SURG 2019; 34:756-762. [PMID: 31809609 DOI: 10.1080/08941939.2019.1690077] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Several studies have demonstrated the feasibility and role of bulky cardiophrenic lymph nodes (CPLNs) resection during primary debulking surgery (PDS) for stage IV ovarian cancer (OC). However, no studies, to date, investigated the accuracy and feasibility of CPLNs assessment and removal during interval debulking surgery (IDS) after neoadjuvant chemotherapy (NACT). MATERIAL AND METHODS A retrospective analysis of consecutive stage IV OC patients who underwent NACT followed by IDS with CPLNs assessment and/or resection from July 2017 to June 2018. Bulky CPLNs were considered for excision when a full-thickness diaphragmatic resection was required in order to achieve complete tumour resection. RESULTS A total of 21 ovarian cancer stage IV patients treated with NACT followed by IDS were identified. Seven (33.3%) patients underwent CPLNs resection due to bulky appearance of the CPLNs at the intraoperative palpation. The final histological examination of the CPLNs reported metastatic disease in four (57%) of seven patients. Complete cytoreduction without residual disease was achieved in five cases (71.4%) while in two case (28.6%) optimal cytoreduction was performed. Intra-operative surgical complications occurred in one patient. One patient had a major postoperative complication (Clavien-Dindo 3). Two cases of postoperative cardiac arrhythmia were observed. CONCLUSIONS CPLNs intraoperative assessment is less accurate during IDS compared to previous PDS studies. CPLNs removal during IDS after NACT for stage IV OC could be safely performed to achieve a complete resection.
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Affiliation(s)
- Ciro Pinelli
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK.,Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Matteo Morotti
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK
| | - Jvan Casarin
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK.,Department of Obstetrics and Gynecology, University of Insubria, Varese, Italy
| | - Roberto Tozzi
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK
| | - Moiad Alazzam
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK
| | - Vasileios K Mavroeidis
- Department of Hepatobiliary and Pancreatic Surgery, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK
| | - Hooman Soleymani Majd
- Department of Gynaecologic Oncology, Oxford University Hospital NHS Trust, Churchill Hospital, Oxford, UK
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