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01-04-2018 | Gynecologic Oncology

Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer

Authors: Roberto Berretta, Vito Andrea Capozzi, Giulio Sozzi, Lavinia Volpi, Valentina Ceni, Mauro Melpignano, Giovanna Giordano, Federico Marchesi, Michela Monica, Maurizio Di Serio, Matteo Riccò, Marcello Ceccaroni

Published in: Archives of Gynecology and Obstetrics | Issue 4/2018

Abstract

Purpose

The aim of this retrospective study is to analyze the prognostic role and the practical implication of mesenteric lymph nodes (MLN) involvements in advanced ovarian cancer (AOC).

Methods

A total of 429 patients with AOC underwent surgery between December 2007 and May 2017. We included in the study 83 patients who had primary (PDS) or interval debulking surgery (IDS) for AOC with bowel resection. Numbers, characteristics and surgical implication of MLN involvement were considered.

Results

Eighty-three patients were submitted to bowel resection during cytoreduction for AOC. Sixty-seven patients (80.7%) underwent primary debulking surgery (PDS). Sixteen patients (19.3%) experienced interval debulking surgery (IDS). 43 cases (51.8%) showed MLN involvement. A statistic correlation between positive MLN and pelvic lymph nodes (PLN) (p = 0.084), aortic lymph nodes (ALN) (p = 0.008) and bowel infiltration deeper than serosa (p = 0.043) was found. A longer overall survival (OS) and disease-free survival was observed in case of negative MLN in the first 20 months of follow-up. No statistical differences between positive and negative MLN in terms of operative complication, morbidity, Ca-125, type of surgery (radical vs supra-radical), length and site of bowel resection, residual disease and site of recurrence were observed.

Conclusions

An important correlation between positive MLN, ALN and PLN was detected; these results suggest a lymphatic spread of epithelial AOC similar to that of primary bowel cancer. The absence of residual disease after surgery is an independent prognostic factor; to achieve this result should be recommended a radical bowel resection during debulking surgery for AOC with bowel involvement.

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics: 2011. CA Cancer J Clin 61(2):69–90. https://doi.org/10.3322/caac.20107.Available CrossRefPubMed

Hudson CN (1968) A radical operation for fixed ovarian tumours. BJOG An Int J Obstet Gynaecol 75(11):1155–1160. https://doi.org/10.1111/j.1471-0528.1968.tb02901.x CrossRef

Scarabelli C, Gallo A, Franceschi S et al. (2000) Primary cytoreductive surgery with rectosigmoid colon resection for patients with advanced epithelial ovarian carcinoma. Cancer 88(2):389–397CrossRefPubMed

Obermair A, Hagenauer S, Tamandl D et al (2001) Safety and efficacy of low anterior en bloc resection as part of cytoreductive surgery for patients with ovarian cancer. Gynecol Oncol 83(1):115–120. https://doi.org/10.1006/gyno.2001.6353 CrossRefPubMed

Berretta R, Marchesi F, Volpi L et al (2016) Posterior pelvic exenteration and retrograde total hysterectomy in patients with locally advanced ovarian cancer: clinical and functional outcome. Taiwan J Obstet Gynecol. 55(3):346–350. https://doi.org/10.1016/j.tjog.2016.04.010 CrossRefPubMed

Hertel H, Diebolder H, Herrmann J et al (2001) Is the decision for colorectal resection justified by histopathologic findings: a prospective study of 100 patients with advanced ovarian cancer. Gynecol Oncol 83(3):481–484. https://doi.org/10.1006/gyno.2001.6338 CrossRefPubMed

Bristow RE, Del Carmen MG, Kaufman HS, Montz FJ (2003) Radical oophorectomy with primary stapled colorectal anastomosis for resection of locally advanced epithelial ovarian cancer. J Am Coll Surg 197(4):565–574. https://doi.org/10.1016/S1072-7515(03)00478-2 CrossRefPubMed

Gillette-Cloven N, Burger RA, Monk BJ et al (2001) Bowel resection at the time of primary cytoreduction for epithelial ovarian cancer. J Am Coll Surg 193(6):626–632. https://doi.org/10.1016/S1072-7515(01)01090-0 CrossRefPubMed

Gallotta V, Fanfani F, Fagotti A et al (2014) Mesenteric lymph node involvement in advanced ovarian cancer patients undergoing rectosigmoid resection: prognostic role and clinical considerations. Ann Surg Oncol 21(7):2369–2375. https://doi.org/10.1245/s10434-014-3558-0 CrossRefPubMed

10.

Gasimli K, Braicu EI, Nassir M et al (2016) Lymph node involvement pattern and survival differences of FIGO IIIC and FIGO IIIA1 ovarian cancer patients after primary complete tumor debulking surgery: a 10-year retrospective analysis of the tumor bank ovarian cancer network. Ann Surg Oncol 23(4):1279–1286. https://doi.org/10.1245/s10434-015-4959-4 CrossRefPubMed

11.

Heitz F, Harter P, Alesina PF et al (2016) Pattern of and reason for postoperative residual disease in patients with advanced ovarian cancer following upfront radical debulking surgery. Gynecol Oncol 141(2):264–270. https://doi.org/10.1016/j.ygyno.2016.03.015 CrossRefPubMed

12.

Jacquet P, Sugarbaker P (1996) Peritoneal carcinomatosis: principles of management. Perit Carcinomatosis Princ Manag 82:359–374. https://doi.org/10.1007/978-1-4613-1247-5 CrossRef

13.

Esquivel J (2007) Cytoreductive surgery for peritoneal malignancies-development of standards of care for the community. Surg Oncol Clin N Am 16(3):653–666. https://doi.org/10.1016/j.soc.2007.04.015 CrossRefPubMed

14.

Vizzielli G, Costantini B, Tortorella L et al (2016) A laparoscopic risk-adjusted model to predict major complications after primary debulking surgery in ovarian cancer: a single-institution assessment. Gynecol Oncol 142(1):19–24. https://doi.org/10.1016/j.ygyno.2016.04.020 CrossRefPubMed

15.

Petrillo M, Vizzielli G, Fanfani F et al (2015) Definition of a dynamic laparoscopic model for the prediction of incomplete cytoreduction in advanced epithelial ovarian cancer: proof of a concept. Gynecol Oncol 139(1):5–9. https://doi.org/10.1016/j.ygyno.2015.07.095 CrossRefPubMed

16.

Fagotti A, Ferrandina G, Fanfani F et al (2006) A laparoscopy-based score to predict surgical outcome in patients with advanced ovarian carcinoma: a pilot study. Ann Surg Oncol 13(8):1156–1161. https://doi.org/10.1245/ASO.2006.08.021 CrossRefPubMed

17.

Gouy S, Goetgheluck J, Uzan C, Duclos J, Duvillard P, Morice P (2012) Prognostic factors for and prognostic value of mesenteric lymph node involvement in advanced-stage ovarian cancer. Eur J Surg Oncol 38(2):170–175. https://doi.org/10.1016/j.ejso.2011.10.006 CrossRefPubMed

18.

Mita MT, Marchesi F, Cecchini S et al (2016) Prognostic assessment of gastric cancer: retrospective analysis of two decades. Acta Biomed 87(2):205–211. http://www.ncbi.nlm.nih.gov/pubmed/27649005. Accessed 2016

19.

Riediger H, Keck T, Wellner U et al (2009) The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 13(7):1337–1344. https://doi.org/10.1007/s11605-009-0919-2 CrossRefPubMed

20.

Sun Z, Xu Y, Li DM et al (2010) Log odds of positive lymph nodes: a novel prognostic indicator superior to the number-based and the ratio-based n category for gastric cancer patients with R0 resection. Cancer 116(11):2571–2580. https://doi.org/10.1002/cncr.24989 CrossRefPubMed

21.

Wang X, Appleby DH, Zhang X, Gan L, Wang JJ, Wan F (2013) Comparison of three lymph node staging schemes for predicting outcome in patients with gastric cancer. Br J Surg 100(4):505–514. https://doi.org/10.1002/bjs.9014 CrossRefPubMed

22.

Dvoretsky PM, Richards KA, Angel C et al. (1998) Distribution of disease at autopsy in 100 women with ovarian cancer. Hum Pathol 19(1):57–63CrossRef

23.

O’Hanlan KA, Kargas S, Schreiber M et al (1995) Ovarian carcinoma metastases to gastrointestinal tract appear to spread like colon carcinoma: implications for surgical resection. Gynecol Oncol 59(2):200–206. https://doi.org/10.1006/gyno.1995.0008 CrossRefPubMed

24.

Petru, Lax, Holzer et al (1998) Mesenteric and mesocolic lymph node metastases from ovarian carcinoma: a clinicopathological analysis. Int J Gynecol Cancer 8(2):119–123. https://doi.org/10.1046/j.1525-1438.1998.09794.x CrossRef

25.

Salani R, Diaz-Montes T, Giuntoli RL, Bristow RE (2007) Surgical management of mesenteric lymph node metastasis in patients undergoing rectosigmoid colectomy for locally advanced ovarian carcinoma. Ann Surg Oncol 14(12):3552–3557. https://doi.org/10.1245/s10434-007-9565-7 CrossRefPubMed

26.

Ong MLH, Schofield JB (2016) Assessment of lymph node involvement in colorectal cancer. World J Gastrointest Surg 8(3):179. https://doi.org/10.4240/wjgs.v8.i3.179 CrossRefPubMedPubMedCentral

27.

Amin MB, Greene FL, Edge SB et al (2017) The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging. CA Cancer J Clin 67(2):93–99. https://doi.org/10.3322/caac.21388 CrossRefPubMed

Title: Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer
Authors: Roberto Berretta
Vito Andrea Capozzi
Giulio Sozzi
Lavinia Volpi
Valentina Ceni
Mauro Melpignano
Giovanna Giordano
Federico Marchesi
Michela Monica
Maurizio Di Serio
Matteo Riccò
Marcello Ceccaroni
Publication date: 01-04-2018
Publisher: Springer Berlin Heidelberg
Published in: Archives of Gynecology and Obstetrics / Issue 4/2018
Print ISSN: 0932-0067
Electronic ISSN: 1432-0711
DOI: https://doi.org/10.1007/s00404-018-4675-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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