Department of Gynecology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba 2608677, Japan.
Department of Gynecology, Chiba University Graduate School of Medicine, 1-8-1 Inohana, Chuou-ku, Chiba, Chiba 2608677, Japan.
Gynecol Oncol. 2020 May;157(2):555-557. doi: 10.1016/j.ygyno.2020.03.004. Epub 2020 Mar 17.
Metastatic lymph node resection around the porta hepatis is sometimes required to achieve complete cytoreduction for ovarian, fallopian tube, and primary peritoneal cancer. Hence, this study aimed to present the surgical approach of peripancreatic lymph node removal around the porta hepatis as part of primary debulking surgery.
A 75-year old woman with stage IIIC primary peritoneal serous carcinoma underwent primary debulking surgery by means of the following procedures: bilateral salpingo-oophorectomy, total hysterectomy, omentectomy, total pelvic peritonectomy, rectosigmoid colectomy with anastomosis, right hemicolectomy, right diaphragm resection, partial jejunal resection, and pelvic and para-aortic lymphadenectomy. Furthermore, she underwent enlarged peripancreatic lymph nodes resection located in the hepatoduodenal ligament and on the posterior pancreatic head. An anatomic variant of the common hepatic artery was identified to be arising from the superior mesenteric artery and not from the celiac artery. The common hepatic artery ran behind the portal vein. We resected the lymph nodes without causing injury of the hepatic artery, portal vein, and common bile duct and achieved complete cytoreduction.
The histological examination revealed high-grade serous carcinoma in three of nine resected peripancreatic lymph nodes. In contrast, only one lymph node metastasized in the interaortocaval region among the 63 resected regional lymph nodes (paraaortic and pelvic lymph nodes).
Metastatic peripancreatic lymph nodes resection around the porta hepatis is feasible and sometimes necessary for cytoreductive surgery for advanced ovarian, fallopian tube, and primary peritoneal cancer.
对于卵巢癌、输卵管癌和原发性腹膜癌，有时需要切除肝门周围的转移性淋巴结，以实现完全减瘤。因此，本研究旨在介绍作为初始肿瘤细胞减灭术一部分的肝门周围胰周淋巴结切除术的手术方法。
一名 75 岁女性患有 IIIC 期原发性腹膜浆液性癌，通过以下程序进行初始肿瘤细胞减灭术：双侧输卵管卵巢切除术、全子宫切除术、网膜切除术、全盆腔腹膜切除术、直肠乙状结肠切除术和吻合术、右半结肠切除术、右膈肌切除术、部分空肠切除术以及盆腔和腹主动脉旁淋巴结切除术。此外，她还接受了扩大的肝门周围胰周淋巴结切除术，这些淋巴结位于肝十二指肠韧带和胰头后方。发现肝固有动脉的解剖学变异是由肠系膜上动脉而不是腹腔动脉发出的。肝固有动脉位于门静脉后方。我们在不损伤肝动脉、门静脉和胆总管的情况下切除了这些淋巴结，实现了完全减瘤。
在 9 个切除的胰周淋巴结中，有 3 个有高级别浆液性癌。相比之下，在 63 个切除的区域淋巴结（腹主动脉旁和盆腔淋巴结）中，只有 1 个淋巴结在主动脉旁转移。
肝门周围胰周淋巴结切除术对于卵巢癌、输卵管癌和原发性腹膜癌的高级别肿瘤细胞减灭术是可行的，有时也是必要的。
