Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

Abstract

Background: In patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer. Methods: The subjects were 25 patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer who underwent systematic dissection of the para-aortic nodes, including the supra-renal PAN, and pelvic lymph nodes (PLN). Patient factors, perioperative factors, the number of dissected lymph nodes, and pathological lymph node metastasis were investigated. Results: Supra-renal PAN metastasis was found in 4/25 patients (16.0%). None of the 14 patients with pT1 or pT2 disease had supra-renal PAN metastasis, while 4/11 patients (36.4%) with pT3 or ypT3 disease had such metastases. None of the patients had isolated supra-renal PAN metastasis, while patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PAN and PLN. Conclusions: In patients with epithelial ovarian cancer, supra-renal PAN metastases might be considered to be distant rather than regional metastases. Further studies are needed to better define the clinical significance of supra-renal PAN metastasis.

Neglected Anatomical Areas in Ovarian Cancer: Significance for Optimal Debulking Surgery

“…The second group is located between the IVC and the abdominal aorta, below the inferior surface of the right liver lobe and below the origin of the superior mesenteric artery. The boundaries of the dissection are as follows: cranial-inferior surface of the left liver lobe; caudal-left inferior suprarenal vein; left-medial portion of the left suprarenal gland; right-medial aspect of the IVC [72]. The importance of suprarenal lymph node metastases, previously considered a predictor of suboptimal cytoreduction, has been increasingly recognized as recent data reported improved feasibility of suprarenal lymphadenectomy using modified surgical techniques (instead of the conventional infrarenal paraaortic approach) [48,[72][73][74].…”

“…Whereas most authors recommend the Kocher maneuver or its modification to gain access to the suprarenal lymph nodes [70,72,74], Daia et al described a left lateral approach to the suprarenal nodes (modification of the Mattox maneuver) and concluded that the left approach provides a better exposure compared to the right one [73]. Surgeons should exercise caution when dissecting the adrenal glands, the suprarenal and renal vessels (anatomical variations of the renal vessels are common), the cisterna chyli and the lumbar lymphatic trunk.…”

“…Komiyama et al conducted the only study examining the metastatic pattern of suprarenal lymph nodes in AEOC [72]. The authors reported involvement of the suprarenal lymph nodes in 15% of cases.…”

Impact of prehabilitation during neoadjuvant chemotherapy and interval cytoreductive surgery on ovarian cancer patients: a pilot study

“…Surgery is an aggressive procedure that disrupts the physiologic status and triggers a general stress response, altering hormonal, metabolic, immunologic, and neurological functions, and NACT treatment may also affect the physiologic status and body function [ 7 ]. In particular, cytoreductive surgery usually requires peritonectomy, lymphadenectomy, visceral resection, and gastrointestinal anastomoses [ 8 , 9 ]. Therefore, it seems appropriate to restore the baseline status of ovarian cancer patients before exposition to another acute stressor such as surgery and especially after NACT.…”

Diagnostic and prognostic values of MMP-9 expression in ovarian cancer: A study based on bioinformatics analysis and meta-analysis

“…Due to its hidden incidence and lack of indicators for early diagnosis, 70-80% of patients with OC were not diagnosed until tumor stage III or IV. 2,3 Although comprehensive treatments such as tumor cell reduction surgery and chemotherapy were used in clinics, the 5-year survival rate has not been notably improved yet, and the mortality rate still ranks first among gynecological malignant tumors. [4][5][6][7] Therefore, the search has been ongoing for early OC markers and valuable predictors of invasion, metastasis, and prognosis.…”