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

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.

Continuous improvement in primary Debulking surgery for advanced ovarian cancer: Do increased complete gross resection rates independently lead to increased progression-free and overall survival?

“…In 2006, our goal for PDS evolved from residual disease ≤10 mm to either CGR or as minimal residual tumor as possible [7]. During 2010 to 2013, 3 additional changes were gradually adopted: routine performance of cardiophrenic lymph node resection [20], use of the selection criteria for NACT as described by Aletti et al [21], and implementation of earlier operative start times [18]. The decision to define 2010 as the division point between Groups 2 and 3 was also influenced by the increase in our NACT rates after 2010 [22].…”

Rare Distant Metastatic Disease of Ovarian and Peritoneal Carcinomatosis: A Review of the Literature

“…Treatment of patients with CPLN involvement includes optimal debulking and complete gross resection options. Optimal debulking surgery is associated with a 68.9 months median overall survival (OS) while patients who obtained a complete gross resection (CGR) had a median OS of 72.3 months [39].…”

Ovarian cancer subtypes and survival in relation to three comprehensive imaging parameters

“…Furthermore, cardio phrenic lymph nodes (CPLN) are located above the abdominal cavity and diaphragm and are, by convention, considered radiologically positive if the short axis in the transaxial plane is ≥5 mm. However, how they should be handled in surgical care and their role in ovarian cancer prognosis have been debated [10,11]. Interestingly, a recent paper (predominantly high grade serous OC) [10] indicated that there was a stronger correlation between CPLN positivity and peritoneal carcinomatosis of the upper abdomen (especially of the diaphragm) than between CPLN positivity and abdominal lymph node status, which makes the two parameters (CT-PCI and CPLN) particularly interesting to study together.…”