Thoracic anatomical landmarks and uniportal VATS cardiophrenic lymph node resection in advanced ovarian cancer

Boria, Félix; Rodríguez-Pérez, María; Vázquez-Vicente, Daniel; Castellanos, Teresa; Chacón, Enrique; Chiva, Luis

doi:10.1136/ijgc-2021-002425

Cited by 3 publications

(2 citation statements)

References 4 publications

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“…CPLN resection can be performed via video-assisted thoracic surgery (VATS) or transabdominally through the subxiphoid or transdiaphragmatic routes. While, VATS mostly requires thoracic surgeon, subxiphoid and transdiaphragmatic approaches can be successfully performed by gynecologic oncologists in many qualified centers (2). The subxiphoid approach is utilized to reach the prepericardiac nodes located in the anterior mediastinum.…”

Section: Introductionmentioning

confidence: 99%

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Khatib¹,

Köse²,

Bağır³

et al. 2022

J Turkish German Gynecol Assoc

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Even the resection's impact of enlarged cardiophrenic lymph nodes (CPLN) on survival still uncertain, it contributes to accurate staging and complete gross resection in advanced ovarian cancer. CPLN resection can be performed via video-assisted thoracic surgery or transabdominally through the subxiphoid or transdiaphragmatic routes. The subxiphoid approach is utilized to reach the prepericardiac nodes located in the anterior mediastinum. The transdiaphragmatic route is used to remove the costophrenic and supradiaphragmatic paracaval lymph nodes located in the middle and posterior mediastinum, respectively. Transdiaphragmatic approach necessitates diaphragm opening and, in most cases, liver mobilization. However, costophrenic nodes can be resected through the subxiphoid route in appropriate patients without opening the diaphragm. Thus, the subxiphoid approach can be firstly preferred to remove the costophrenic lymph nodes, in cases whose diaphragm resection is not anticipated, and especially when the resection procedure is planned to include the prepericardiac nodes. In this video article, we present the method of resecting both prepericardiac and costophrenic lymph nodes through the subxiphoid approach in an advanced ovarian cancer case. The subxiphoid virtual space between the pericardium and diaphragm was developed. The observed and palpated CPLNs were dissected and excised from the prepericardiac and right latero-cardiac spaces. Thereafter, diaphragm peritoneum beneath the right costophrenic nodes was dissected. After determining the enlarged costophrenic node by palpation, the sternal and costal diaphragmatic attachments were incised and the right latero-cardiac space was extended. When the node was reached, it was grasped and pulled with curved-ring forceps and ultimately resected.

show abstract

Section: Introductionmentioning

confidence: 99%

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Khatib¹,

Köse²,

Bağır³

et al. 2022

J Turkish German Gynecol Assoc

View full text Add to dashboard Cite

show abstract

“…CPLN resection can be performed via video-assisted thoracic surgery (VATS) or transabdominally, through the subxiphoid or transdiaphragmatic routes. While using VATS will usually need the involvement of a thoracic surgeon, the subxiphoid and transdiaphragmatic approaches can be successfully performed by gynecological oncologists in many centers ( 2 ). The subxiphoid approach is normally used to reach the prepericardiac nodes, located in the anterior mediastinum.…”

Section: Introductionmentioning

confidence: 99%

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Khatib¹,

Köse²,

Bağır³

et al. 2022

J Turkish German Gynecol Assoc

View full text Add to dashboard Cite

When enlarged cardiophrenic lymph nodes (CPLN) are resected the impact on survival is still uncertain, but resection contributes to accurate staging and complete gross resection in advanced ovarian cancer. CPLN resection can be performed via video-assisted thoracic surgery or transabdominally through the subxiphoid or transdiaphragmatic routes. The subxiphoid approach is used to reach the prepericardiac nodes located in the anterior mediastinum. The transdiaphragmatic route is used to remove the costophrenic and supradiaphragmatic paracaval lymph nodes located in the middle and posterior mediastinum, respectively. However, the transdiaphragmatic approach necessitates diaphragm opening and, in most cases, liver mobilization. Costophrenic nodes can be resected through the subxiphoid route in appropriate patients without opening the diaphragm. Thus, the subxiphoid approach may be preferred to remove the costophrenic lymph nodes, in cases in whom diaphragm resection is not anticipated, and especially when the resection procedure is planned to include the prepericardiac nodes. In this video article, we present the method of resecting both prepericardiac and costophrenic lymph nodes using only the subxiphoid approach in a case of advanced ovarian cancer. The subxiphoid virtual space between the pericardium and diaphragm was developed. The observed and palpated CPLNs were dissected and excised from the prepericardiac and right latero-cardiac spaces. Thereafter, diaphragm peritoneum beneath the right costophrenic nodes was dissected. After identifying any enlarged costophrenic nodes by palpation, the sternal and costal diaphragmatic attachments were incised and the right latero-cardiac space was extended. When the single enlarged node was reached, it was grasped and pulled with curved-ring forceps and ultimately resected.

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Intrathoracic surgery as part of primary cytoreduction for advanced ovarian cancer: The evolution of a “pelvic” surgeon

Fotopoulou¹

2023

Gynecologic Oncology

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Thoracic anatomical landmarks and uniportal VATS cardiophrenic lymph node resection in advanced ovarian cancer

Cited by 3 publications

References 4 publications

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Cardiophrenic and costophrenic lymph node resection via subxiphoid approach only

Intrathoracic surgery as part of primary cytoreduction for advanced ovarian cancer: The evolution of a “pelvic” surgeon

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