Skip to main content

Advertisement

SpringerLink
Log in

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

  • Gynecologic Oncology
  • Published:
Archives of Gynecology and Obstetrics Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. 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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  3. 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):389–397

    Article  CAS  PubMed  Google Scholar 

  4. 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

    Article  CAS  PubMed  Google 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

    Article  PubMed  Google Scholar 

  6. 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

    Article  CAS  PubMed  Google Scholar 

  7. 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

    Article  PubMed  Google Scholar 

  8. 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

    Article  CAS  PubMed  Google Scholar 

  9. 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

    Article  PubMed  Google 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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  Google Scholar 

  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

    Article  PubMed  Google 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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google 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

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  CAS  PubMed  Google Scholar 

  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):57–63

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  Google Scholar 

  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

    Article  PubMed  Google Scholar 

  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

    Article  PubMed  PubMed Central  Google Scholar 

  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

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Obstetrics and Gynecology of Parma, University of Parma, Via Gramsci No. 14, 43125, Parma, Italy

    Roberto Berretta, Vito Andrea Capozzi, Giulio Sozzi, Lavinia Volpi, Valentina Ceni, Giovanna Giordano, Federico Marchesi, Michela Monica & Maurizio Di Serio

  2. The Department of Obstetrics and Gynecology of Oglio Po, Cremona, Italy

    Mauro Melpignano

  3. Local Health Unit of Reggio Emilia, Department of Public Health, Reggio Emilia, Italy

    Matteo Riccò

  4. Department of Obstetrics and Gynecology, Sacred Heart Hospital of Negrar, Verona, Italy

    Marcello Ceccaroni

Authors
  1. Roberto Berretta
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Vito Andrea Capozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Giulio Sozzi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lavinia Volpi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Valentina Ceni
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Mauro Melpignano
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Giovanna Giordano
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Federico Marchesi
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Michela Monica
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Maurizio Di Serio
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Matteo Riccò
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Marcello Ceccaroni
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

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.

Corresponding author

Correspondence to Vito Andrea Capozzi.

Ethics declarations

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.

Ethical approval

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

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Berretta, R., Capozzi, V.A., Sozzi, G. et al. Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer. Arch Gynecol Obstet 297, 997–1004 (2018). https://doi.org/10.1007/s00404-018-4675-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00404-018-4675-y

Keywords

Search

Navigation