Renee A Cowan1, Jill Tseng1, Vijayashree Murthy1, Radhika Srivastava1, Kara C Long Roche2, Oliver Zivanovic2, Ginger J Gardner2, Dennis S Chi2, Bernard J Park3, Yukio Sonoda4. 1. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA. 2. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. 3. Thoracic Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, NY, USA. 4. Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Obstetrics and Gynecology, Weill Cornell Medical College, New York, NY, USA. Electronic address: sonoday@mskcc.org.
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.
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.
Authors: Tae-Hyung Kim; Myong Cheol Lim; Se Ik Kim; Sang-Soo Seo; Sun Ho Kim; Sang-Yoon Park Journal: Ann Surg Oncol Date: 2015-12-29 Impact factor: 5.344
Authors: Vasileios D Sioulas; Maria B Schiavone; David Kadouri; Oliver Zivanovic; Kara Long Roche; Roisin O'Cearbhaill; Nadeem R Abu-Rustum; Douglas A Levine; Yukio Sonoda; Ginger J Gardner; Mario M Leitao; Dennis S Chi Journal: Gynecol Oncol Date: 2017-02-21 Impact factor: 5.482
Authors: Andreas du Bois; Alexander Reuss; Eric Pujade-Lauraine; Philipp Harter; Isabelle Ray-Coquard; Jacobus Pfisterer Journal: Cancer Date: 2009-03-15 Impact factor: 6.860
Authors: Dennis S Chi; Corinna C Franklin; Douglas A Levine; Faina Akselrod; Paul Sabbatini; William R Jarnagin; Ronald DeMatteo; Elizabeth A Poynor; Nadeem R Abu-Rustum; Richard R Barakat Journal: Gynecol Oncol Date: 2004-09 Impact factor: 5.482
Authors: Rudy S Suidan; Pedro T Ramirez; Debra M Sarasohn; Jerrold B Teitcher; Svetlana Mironov; Revathy B Iyer; Qin Zhou; Alexia Iasonos; Harold Paul; Masayoshi Hosaka; Carol A Aghajanian; Mario M Leitao; Ginger J Gardner; Nadeem R Abu-Rustum; Yukio Sonoda; Douglas A Levine; Hedvig Hricak; Dennis S Chi Journal: Gynecol Oncol Date: 2014-07-11 Impact factor: 5.482
Authors: Giorgio Bogani; Antonino Ditto; Fabio Martinelli; Domenica Lorusso; Valentina Chiappa; Cristina Donfrancesco; Violante Di Donato; Alice Indini; Giovanni Aletti; Francesco Raspagliesi Journal: Int J Gynecol Cancer Date: 2016-02 Impact factor: 3.437
Authors: Pauline Wimberger; Michael Wehling; Nils Lehmann; Rainer Kimmig; Barbara Schmalfeldt; Alexander Burges; Philipp Harter; Jacobus Pfisterer; Andreas du Bois Journal: Ann Surg Oncol Date: 2010-02-18 Impact factor: 5.344
Authors: Jill H Tseng; Renee A Cowan; Qin Zhou; Alexia Iasonos; Maureen Byrne; Tracy Polcino; Clarissa Polen-De; Ginger J Gardner; Yukio Sonoda; Oliver Zivanovic; Nadeem R Abu-Rustum; Kara Long Roche; Dennis S Chi Journal: Gynecol Oncol Date: 2018-08-17 Impact factor: 5.482
Authors: Thomas Boerner; Olga T Filippova; Andrew J Chi; Alexia Iasonos; Qin C Zhou; Kara Long Roche; Oliver Zivanovic; Bernard J Park; James Huang; David R Jones; Nadeem R Abu-Rustum; Ginger Gardner; Yukio Sonoda; Dennis S Chi Journal: Gynecol Oncol Date: 2020-08-10 Impact factor: 5.482
Authors: Lucas Minig; Miguel Arraras; Cristina Zorrero; Pedro Martinez; Manuel Patron; Juan Carlos Peñalver Journal: Ecancermedicalscience Date: 2017-11-16
Authors: Dib Sassine; Dimitrios Nasioudis; Kathryn Miller; Rebecca Chang; Derman Basaran; Evan S Smith; Sarah Ehmann; Dennis S Chi Journal: Gynecol Oncol Rep Date: 2020-12-11
Authors: Ghanim Khatib; Sevgül Köse; Emine Bağır; Ümran Küçükgöz Güleç; Ahmet Barış Güzel; Mehmet Ali Vardar Journal: J Turk Ger Gynecol Assoc Date: 2022-03-10
Authors: Hanna Sartor; Maria Bjurberg; Mihaela Asp; Anna Kahn; Jenny Brändstedt; Päivi Kannisto; Karin Jirström Journal: J Ovarian Res Date: 2020-03-07 Impact factor: 4.234