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The presence of enlarged cardiophrenic lymph nodes on preoperative imaging classifies patients with advanced ovarian cancer as International Federation of Gynecology and Obstetrics stage IV. It is not uncommon to find cardiophrenic lymph nodes when there is bulky disease in the upper abdomen, as these receive lymphatic drainage from the diaphragm and abdominal cavity.1 When metastatic disease is found in these nodes, it is associated with a poor prognosis.2 However, suspicious preoperative cardiophrenic lymph nodes should not preclude primary cytoreductive surgery when complete abdominal cytoreduction can be achieved otherwise.
Several studies have analyzed the feasibility and safety of removing enlarged cardiophrenic lymph nodes during cytoreductive surgery for advanced ovarian cancer.1–8 Cardiophrenic lymph nodes were considered suspicious (>5 mm) on computed tomography scan in most studies. Following these criteria, malignancy was confirmed on the final pathology analysis in 45–95% of cases.3–6 The most common complications related to cardiophrenic lymph node resection were pleural effusion and pneumothorax.6 Major complications (Clavien–Dindo grade 3 and above) occurred in 0–9% of patients.1 4 6–8 The median time for cytoreductive surgery in patients with suspicious cardiophrenic lymph nodes ranged from 333 to 470 min.4–8 The median operative time for nodal resection was 28 min.1 4
The impact of resection of cardiophrenic nodes on overall survival and progression free survival remains unclear. One study has evaluated this question, and findings revealed that patients with a stage IV disease caused by supradiaphragmatic lymph nodal metastases that were surgically resected (40 patients) had no difference in overall survival or progression free survival compared with stage IV patients with other metastases (28 patients). Only eight patients were stage IV caused by cardiophrenic lymph node metastases.
In summary, cardiophrenic lymph node resection is a feasible and safe technique. However, no studies to date have shown a benefit in overall survival or progression free survival.
Contributors All authors made substantial contributions to the conception of the work.
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 for publication Not required.
Provenance and peer review Not commissioned; internally peer reviewed.
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