Cardiophrenic lymph node resection in cytoreduction for primary advanced or recurrent epithelial ovarian carcinoma: a cohort study

Abstract

ObjectivesTo evaluate the clinical outcomes of epithelial ovarian carcinoma patients who underwent cardiophrenic lymph node resection.MethodsWe retrospectively reviewed the records of all surgically treated patients with advanced epithelial ovarian carcinoma (stages IIIC–IV) who underwent cardiophrenic lymph node resection between 2002 and 2018. Only those in whom cardiophrenic lymph node involvement was the only detectable extra-abdominal disease were included. Patients with suspected cardiophrenic lymph node metastasis on staging images underwent a transdiaphragmatic incision to access the para-cardiac space after complete abdominal cytoreduction achievement. Data on disease-free survival, overall survival, and surgical procedures performed concurrently with cardiophrenic lymph node resection were collected.ResultsOf the total 456 patients, 29 underwent cardiophrenic lymph node resection; of these, 24 patients met the inclusion criteria. Twenty-two, one, and one patients had high grade serous epithelial ovarian carcinoma, low grade epithelial ovarian carcinoma, and ovarian carcinosarcoma, respectively. Ten patients had recurrent disease (recurrence group). Fourteen patients underwent cytoreduction during primary treatment (primary debulking group); four underwent cytoreduction after neoadjuvant chemotherapy. Cardiophrenic lymph node resection was performed on the right side in 19 patients, left side in three, and bilaterally in two. The average procedural duration was 28 minutes, with minimal blood loss and no severe complications. Twenty-one patients had cardiophrenic lymph node positivity. The median disease-free intervals were 17 and 12 months in the recurrent and primary debulking surgery groups, respectively. The mediastinum was the first recurrence site in 10 patients. Five patients developed brain metastases. Five patients had an overall survival beyond 50 months.ConclusionsAlthough rare, the cardiophrenic lymph nodes may be a site of metastasis of ovarian cancer. Although their presence might indicate future recurrence, some patients may achieve long-term survival. Resection should be considered in cases of suspicious involvement to confirm extra-abdominal disease and achieve complete cytoreduction.

Recurrence patterns in patients with abnormal cardiophrenic lymph nodes at ovarian cancer diagnosis

“…Surgical resection of these nodes via the transdiaphragmatic approach has become common at some institutions. This has been shown to be both feasible and safe, with a marginal increase in operating time and short-term morbidity 5 7 12–14. Initial long-term data have suggested that surgical resection has little role in extending survival, but has not identified the effect of this practice on sites of recurrence utilizing a comparison group 8…”

Survival in Advanced-Stage Epithelial Ovarian Cancer Patients with Cardiophrenic Lymphadenopathy Who Underwent Cytoreductive Surgery: A Systematic Review and Meta-Analysis

“…Thirteen articles described retrospective cohort studies [ 9 , 11 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ], one was a case report [ 34 ], and one a case series [ 35 ]. The studies spanned the period from 1997 to 2020.…”

“…Despite this finding, only a slightly higher proportion of perioperative complications was found for the CPLN adenopathy group (26% vs. 23%). Eight studies provided survival outcomes [ 9 , 11 , 24 , 25 , 26 , 29 , 32 , 33 ]. The pooled median PFS time was 14.6 months (95% CI 4.9–24.4) vs. 27.8 months (95% CI 3.2–52.5) in patients with and without CPLN adenopathy, respectively.…”

“…Regarding the impact of CPLN resection during cytoreductive surgery, nine studies reported the mean size of preoperative suspicious nodes [ 11 , 23 , 24 , 25 , 26 , 28 , 29 , 32 , 34 ]. The baseline characteristics are presented in Table 2 .…”

“…The presence of enlarged CPLN was found to be associated with poor survival, regardless of the presence of peritoneal metastases [ 9 ]. Currently, the surgical feasibility of CPLN resection has been reported [ 11 , 12 ]. However, there is still no consensus on the survival benefit of these issues.…”