Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer
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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).
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.
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.
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.
KeywordsMesenteric lymph nodes Pelvic lymph nodes Aortic lymph nodes Ovarian cancer Bowel infiltration
RB and VAC conceived the study, participated in its design and coordination and drafted the manuscript; MM, GS, MDS, MM, FM and GG participated in the design and interpretation of the data; VC and LV participated in the design and coordination of the study and performed the measurement; MR participated in the design of the study and performed the statistical analysis; MC conceived of the study, and participated in its design and coordination and helped to draft the manuscript. All authors read and approved the final manuscript.
Compliance with ethical standards
Conflict of interest
Author Capozzi Vito Andrea declare that he has no conflict of interest. Author Roberto Berretta declare that he has no conflict of interest. Author Giulio Sozzi declare that he has no conflict of interest. Author Lavinia Volpi declare that she has no conflict of interest. Author Valentina Ceni declare that she has no conflict of interest. Author Mauro Melpignano declare that he has no conflict of interest. Author Giovanna Giordano declare that she has no conflict of interest. Author Federico Marchesi declare that he has no conflict of interest. Author Michela Monica declare that she has no conflict of interest. Author Maurizio Di Serio declare that he has no conflict of interest. Author Marcello Ceccaroni declare that he has no conflict of interest. Author Matteo Riccò declare that he has no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- 2.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 CrossRefGoogle Scholar
- 5.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 CrossRefPubMedGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- 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 CrossRefPubMedGoogle Scholar
- 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
- 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 CrossRefPubMedGoogle Scholar