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abstract
Highlights
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- Importance of complete resection in primary ovarian cancer
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- Excision of suspicious cardiophrenic lymph nodes via a transdiaphragmatic approach
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- Feasibility, management and complications of resection
Abstract
Objective
Debulking
surgery for advanced ovarian cancer does not routinely include opening
of the thorax. Even systematic lymphadenectomy does not commonly extend
to lymph nodes above the diaphragm. We evaluated the outcome of
systematic resection of suspicious cardiophrenic lymph nodes detected on
preoperative CT-scan in patients with advanced epithelial ovarian
cancer (EOC).
Methods
Single-center,
prospective series of 196 consecutive patients with EOC undergoing
primary debulking surgery between June 2013 and June 2015. Suspicious
cardiophrenic lymph nodes were defined as ≥ 10 mm on the short axis
diagnosed in pre-operative CT-scan and were removed if intra-abdominal
debulking resulted in complete resection or residual tumor < 10 mm
and the patients' performance status allowed this additional procedure.
Removal of suspicious cardiophrenic lymph nodes was performed via a
trans-diaphragmatic approach.
Results
Thirty
(15%) out of 196 EOC patients had radiologically suspicious
cardiophrenic lymph nodes ≥ 10 mm and complete resection or residual
tumor < 10 mm. Twenty-seven out of the thirty patients had at least
one confirmed metastatic cardiophrenic lymph node. Metastatic
cardiophrenic lymph nodes were associated with extensive intra-abdominal
tumor spread in the upper abdomen.
Conclusions
Patients
with suspicious cardiophrenic lymph nodes detected by preoperative
CT-scan had histologically confirmed metastasis in 90% of cases. The
surgical procedure is feasible without major complications if performed
by experienced gyneco-oncologists. The prognostic value of this
procedure should be evaluated in larger controlled studies.
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