Cowan Renee A, Tseng Jill, Murthy Vijayashree, Srivastava Radhika, Long Roche Kara C, Zivanovic Oliver, Gardner Ginger J, Chi Dennis S, Park Bernard J, Sonoda Yukio
Gynecology Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
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.
Gynecol Oncol. 2017 Nov;147(2):262-266. doi: 10.1016/j.ygyno.2017.09.001. Epub 2017 Sep 6.
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.
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.
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).
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.
在晚期卵巢癌的初始治疗中，对增大的心膈角淋巴结（CPLN）进行手术切除尚未得到广泛研究。我们报告了一组在初次肿瘤细胞减灭术（CRS）期间接受CPLN切除的患者，研究其可行性、安全性以及对临床结局的潜在影响。
我们确定了2001年1月至2013年12月期间在本机构接受初次CRS/CPLN切除的所有IIIB-IV期高级别上皮性卵巢癌患者。收集了临床和病理数据，并进行了统计学检验。
54例患者接受了CPLN切除。所有患者术前影像学检查均显示CPLN增大。增大的CPLN的中位直径为1.3cm（范围0.6-2.9cm）。患者中位年龄为59岁（范围41-74岁）。48例（88.9%）接受经膈切除术；6例（11.1%）接受电视辅助胸腔镜手术。切除的淋巴结中位数量为3个（范围1-23个）。转移阳性的淋巴结中位数量为2个（范围0-22个）。51/54例（94.4%）有阳性淋巴结。51例（94.4%）放置了胸管；拔除胸管的中位时间为4天（范围2-12天）。44例（81.4%）有腹膜癌转移。19例（35%）发生了严重术后并发症；其中4例（7%）与手术相关。辅助化疗的中位时间为40天（范围19-205天）。所有患者均实现了最佳肿瘤细胞减灭，30例（55.6%）无可见残留病灶。中位无进展生存期为17.2个月（95%CI 12.6-21.8）；中位总生存期为70.1个月（95%CI 51.2-89.0）。
术前影像学检查可发现增大的CPLN，可能提示转移。切除可发现腹外疾病，确认IV期疾病，实现最佳肿瘤细胞减灭。在合适的情况下，该手术可行、安全，且不延迟化疗。对于部分患者，可能改善生存。
