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


Authors: Cowan, R. A.; Tseng, J.; Murthy, V.; Srivastava, R.; Long Roche, K. C.; Zivanovic, O.; Gardner, G. J.; Chi, D. S.; Park, B. J.; Sonoda, Y.
Article Title: 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: 1.3 cm (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. © 2017 Elsevier Inc.
Keywords: adult; aged; disease-free survival; middle aged; cancer surgery; major clinical study; overall survival; cancer recurrence; advanced cancer; multimodality cancer therapy; cancer patient; disease free survival; cancer staging; follow up; lymph node metastasis; antineoplastic agent; lymph node dissection; lymph nodes; lymphatic metastasis; neoplasm staging; lymph node excision; ovarian cancer; cytoreductive surgery; ovarian neoplasms; metastasis; progression free survival; cohort studies; cohort analysis; pathology; diagnostic imaging; lung embolism; feasibility study; feasibility studies; adjuvant chemotherapy; lymph node; surgical infection; ovary carcinoma; pleura effusion; safety; kaplan meier method; carcinomatous peritonitis; diaphragm; video assisted thoracoscopic surgery; adult respiratory distress syndrome; neoplasms, glandular and epithelial; kaplan-meier estimate; clinical outcome; radical surgery; procedures; chylothorax; primary cytoreductive surgery; humans; human; female; priority journal; article; cardiophrenic lymph nodes; optimal tumor debulking; paracardiac lymph nodes; supradiaphragmatic lymph nodes
Journal Title: Gynecologic Oncology
Volume: 147
Issue: 2
ISSN: 0090-8258
Publisher: Elsevier Inc.  
Date Published: 2017-11-01
Start Page: 262
End Page: 266
Language: English
DOI: 10.1016/j.ygyno.2017.09.001
PUBMED: 28888540
PROVIDER: scopus
PMCID: PMC6085750
DOI/URL:
Notes: Article -- Export Date: 1 December 2017 -- Source: Scopus
Altmetric Score
MSK Authors
  1. Ginger J Gardner
    140 Gardner
  2. Dennis S Chi
    508 Chi
  3. Yukio Sonoda
    293 Sonoda
  4. Oliver Zivanovic
    131 Zivanovic
  5. Bernard J Park
    159 Park
  6. Kara Christine Long
    64 Long
  7. Jill   Tseng
    21 Tseng
  8. Renee Antonette Woodburn Cowan
    13 Cowan
  9. Vijayashree Murthy
    1 Murthy