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Cardiophrenic lymph node resection in cytoreduction for primary advanced or recurrent epithelial ovarian carcinoma: a cohort study
  1. Andre Lopes1,2,
  2. Ronaldo Lucio Rangel Costa1,3,4,
  3. Raphael di Paula3,4,5,
  4. Cristina Anton6,
  5. Ytauan Calheiros3,4,5,
  6. Vivian Sartorelli1,
  7. Yara Mitie Kanashiro3,4,5,
  8. João Alves de Lima3,4,5,
  9. Alayne Yamada7,
  10. Gabriel Lowndes de S Pinto1,
  11. Maria Regina Vianna8,
  12. Maria Luiza Nogueira Dias Genta6,
  13. Ulysses Ribeiro Jr2 and
  14. Marcelo Oliveira dos Santos3
  1. 1 Gynecology Department, Instituto Brasileiro de Controle do Cancer (IBCC), Sao Paulo, Brazil
  2. 2 Gastroenterology Department, Digestive Surgery Division, Sao Paulo Cancer Institute, University of Sao Paulo School of Medicine ICESP-HCFMUSP, Sao Paulo, Brazil
  3. 3 Hospital Alemao Oswaldo Cruz, Oncology Center, Sao Paulo, Brazil
  4. 4 Hospital Beneficencia Portuguesa de Sao Paulo, Sao Paulo, Brazil
  5. 5 Hospital do Servidor Publico Estadual (IAMSPE), Sao Paulo, Brazil
  6. 6 Obstetrics and Gynecology Department, Sao Paulo Cancer Institute, University of Sao Paulo School of Medicine ICESP-HCFMUSP, Sao Paulo, Brazil
  7. 7 Clinical Research Department, IBCC, Sao Paulo, Brazil
  8. 8 CICAP Pathology, Hospital Alemao Oswaldo Cruz, Oncology Center, Sao Paulo, Brazil
  1. Correspondence to Andre Lopes, Gynecology Department, Instituto Brasileiro de Controle do Câncer, São Paulo 03102-002, Brazil; andrelopes1002{at}


Objectives To evaluate the clinical outcomes of epithelial ovarian carcinoma patients who underwent cardiophrenic lymph node resection.

Methods We retrospectively reviewed the records of all surgically treated patients with advanced epithelial ovarian carcinoma (stages IIIC–IV) who underwent cardiophrenic lymph node resection between 2002 and 2018. Only those in whom cardiophrenic lymph node involvement was the only detectable extra-abdominal disease were included. Patients with suspected cardiophrenic lymph node metastasis on staging images underwent a transdiaphragmatic incision to access the para-cardiac space after complete abdominal cytoreduction achievement. Data on disease-free survival, overall survival, and surgical procedures performed concurrently with cardiophrenic lymph node resection were collected.

Results Of the total 456 patients, 29 underwent cardiophrenic lymph node resection; of these, 24 patients met the inclusion criteria. Twenty-two, one, and one patients had high grade serous epithelial ovarian carcinoma, low grade epithelial ovarian carcinoma, and ovarian carcinosarcoma, respectively. Ten patients had recurrent disease (recurrence group). Fourteen patients underwent cytoreduction during primary treatment (primary debulking group); four underwent cytoreduction after neoadjuvant chemotherapy. Cardiophrenic lymph node resection was performed on the right side in 19 patients, left side in three, and bilaterally in two. The average procedural duration was 28 minutes, with minimal blood loss and no severe complications. Twenty-one patients had cardiophrenic lymph node positivity. The median disease-free intervals were 17 and 12 months in the recurrent and primary debulking surgery groups, respectively. The mediastinum was the first recurrence site in 10 patients. Five patients developed brain metastases. Five patients had an overall survival beyond 50 months.

Conclusions Although rare, the cardiophrenic lymph nodes may be a site of metastasis of ovarian cancer. Although their presence might indicate future recurrence, some patients may achieve long-term survival. Resection should be considered in cases of suspicious involvement to confirm extra-abdominal disease and achieve complete cytoreduction.

  • cardiophrenic lymph nodes
  • cytoreductive surgery
  • secondary cytoreduction
  • ovarian carcinoma

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  • Contributors AL secured the cases, conducted the literature review, and prepared the manuscript. All authors contributed to writing the manuscript and read and approved the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Ethics approval This study was approved by the research ethics committees of Instituto Brasileiro de Controle do Câncer (reference No 2.449.744) and Instituto do Câncer do Estado de São Paulo (reference No 2.647.141).

  • Provenance and peer review Not commissioned, externally peer reviewed.