Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection

Baiocchi, Glauco; Cestari, L. A.; Macêdo, Mariana Petaccia de; Oliveira, Renato Almeida Rosa de; Fukazawa, Elza Mieko; Faloppa, Carlos Chaves; Kumagai, Lillian Yuri; Badiglian-Filho, Levon; Menezes, Ademir Narciso Oliveira; Cunha, Isabela W.; Soares, Fernando Augusto

doi:10.1002/jso.21940

Cited by 19 publications

(18 citation statements)

References 52 publications

(60 reference statements)

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“…Second, we found a 42.3 % metastatic spread to mesenteric lymph nodes, in keeping with another study [16]. Other authors report figures that differ significantly from ours [15,17] and correlate it to certain pathologic variables, such as depth of colorectal-wall invasion [15], spread to retroperitoneal lymph nodes [17], or both [18], or the amount of the large bowel resected [14]. In our experience, whenever metastatic peritoneal spread invades the colorectal wall, one can reasonably expect mesenteric lymph node metastasis equal to or more frequent than that found in the pelvic and interaortocaval (locoregional) stations.…”

Section: Pathologysupporting

confidence: 88%

Pathology of Peritoneal Surface Malignancies

Ciardi

Giorgio²

2015

Treatment of Peritoneal Surface Malignancies

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Section: Pathologysupporting

confidence: 88%

Pathology of Peritoneal Surface Malignancies

Ciardi

Giorgio²

2015

Treatment of Peritoneal Surface Malignancies

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“…For example, Park et al related malignant mesenteric lymph node spread to the depth of colorectal wall invasion [31], Salani et al to retroperitoneal lymph-node spread [33] and Lax et al to the amount of colorectum resected [28]. In their later study Baiocchi et al found a significant correlation between mesenteric lymph node spread and the depth of colorectal wall invasion and the presence of metastases at the retroperitoneal lymph node stations [34]. Our experience underlines that whenever metastatic peritoneal spread in advanced ovarian cancer invades the colorectal wall, one can reasonably expect mesenteric lymph node involvement equal to or even greater than that in the typical pelvic and interaortocaval locoregional lymph node stations (Table 3).…”

Section: Discussionmentioning

confidence: 99%

Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases

et al. 2013

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BackgroundMore information is needed on the anatomopathological outcome variables indicating the appropriate surgical strategy for the colorectal resections often needed during cytoreduction for ovarian cancer.MethodsFrom a phase-II study cohort including 70 patients with primary advanced or recurrent ovarian cancer with diffuse peritoneal metastases treated from November 2000 to April 2009, we selected for this study the 52 consecutive patients who needed colorectal resection. Data collected included type of colorectal resection, peritoneal cancer index (PCI), histopathology (depth of bowel-wall invasion and lymph-node spread), cytoreduction rate and outcome. Correlations were tested between possible prognostic factors and Kaplan-Meier five-year overall and disease-free survival. A Cox multivariate regression model was used to identify independent variables associated with outcome.ResultsIn the 52 patients, the optimal cytoreduction rate was 86.5% (CC0/1). In all patients, implants infiltrated deeply into the bowel wall, in 75% of the cases up to the muscular and mucosal layer. Lymph-node metastases were detected in 50% of the cases; mesenteric nodes were involved in 42.3%. Most patients (52%) had an uneventful postoperative course. Operative mortality was 3.8%. The five-year survival rate was 49.9% and five-year disease-free survival was 36.7%. Cox regression analysis identified as the main prognostic factors completeness of cytoreduction and depth of bowel wall invasion.ConclusionsOur findings suggest that the major independent prognostic factors in patients with advanced ovarian cancer needing colorectal resections are completeness of cytoreduction and depth of bowel wall invasion. Surgical management and pathological assessment should be aware of and deal with dual locoregional and mesenteric lymphatic spread.

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“…For example, in a series of total pelvic exenteration for recurrent gynecological cancer, Sardain et al16 and Mourton et al17 reported that the rate of mesorectal nodal metastasis was 19% and 10%, respectively. They also found that MRNM is common in patients with rectal wall involvement in recurrent cervical cancer as well as ovarian cancer 18. This is understandable as rectal cancers normally drain into into the mesorectal lymph nodes.…”

Section: Discussionmentioning

confidence: 93%

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

Cordero-Gallardo

Burnett

McNamara

et al. 2019

Int J Gynecol Cancer

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ObjectiveTo evaluate the incidence and risk factors for mesorectal node metastasis (MRNM) in locally advanced cervical cancer.Methods/MaterialsWe performed an observational retrospective cohort study of 122 patients with cervical cancer who received definitive chemo-radiation treatment between December 2013 and June 2017 to evaluate the incidence of MRNM. Three diagnostic radiologists assessed all available pre-treatment images. In this study, the pelvic node metastasis was defined as ≥ 1.0 cm and MRNM as ≥ 0.5 cm for CT and MRI scans and as a maximum standardized uptake value of > 2.5 for PET/CT. The relationship of MRNM with FIGO stage, pelvic node metastasis, and mesorectal fascia involvement was evaluated.ResultsThe incidence of MRNM in all 122 patients was 8 (6.6%). However, in advanced stage (III– IV) patients, MRNM occurred in 4 of 39 (10.3%) compared with 4 of 83 (4.8%) in early stage (IB1–IIB) patients (p = 0.27). In patients with a positive pelvic node, MRNM occurred in 7 of 55 (12.7%) and 1 of 67 (1.5%) in those with negative pelvic node (p = 0.02). In addition, the incidence of MRNM was 3 of 9 (33.3%) in the presence of mesorectal fascia involvement and 5 of 113 (4.4%) among those without mesorectal fascia involvement (p = 0.013).ConclusionThis study indicates that pelvic node metastasis and mesorectal fascia involvement are high-risk factors for MRNM. Therefore, vigilance of reviewing images in the mesorectum for MRNM is necessary for high-risk patients.

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Surgical implications of mesenteric lymph node metastasis from advanced ovarian cancer after bowel resection

Abstract: Resection of regional lymph nodes of affected organs that is similar to surgical procedures that are performed for colorectal carcinoma is an appropriate, optimal debulking surgery for patients with ovarian carcinoma.

Cited by 19 publications

References 52 publications

Pathology of Peritoneal Surface Malignancies

Pathology of Peritoneal Surface Malignancies

Depth of colorectal-wall invasion and lymph-node involvement as major outcome factors influencing surgical strategy in patients with advanced and recurrent ovarian cancer with diffuse peritoneal metastases

Incidence of mesorectal node metastasis in locally advanced cervical cancer: its therapeutic implications

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