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Cardiophrenic lymph nodes in advanced ovarian cancer
  1. Nuria Agusti1,
  2. Giulio Bonaldo2,
  3. Ryan M Kahn3,
  4. Andrea Rosati4,
  5. Dania Nachira5,
  6. Teresa L Pan6,
  7. Anisa Mburu7,
  8. Gvantsa Kochiashvili8,9,
  9. Pilar Paredes10,
  10. Heng-Cheng Hsu11,
  11. Jennifer Davies-Oliveira12 and
  12. Pedro T Ramirez13
  1. 1Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2Department of Women and Children's Health, Clinic of Gynecology and Obstetrics, University of Padova, Padova, Italy
  3. 3Department of Obstetrics & Gynecology, Weill Cornell Medicine, New York, New York, USA
  4. 4Dipartimento per la salute della Donna e del Bambino e di Sanita Pubblica, Fondazione Policlinico Universitario A. Gemelli, IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  5. 5Department of General Thoracic Surgery, Fondazione Policlinico Universitario "A.Gemelli", IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
  6. 6Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
  7. 7Department of Gynecology and Obstetrics, Aga Khan Hospital Mombasa, Mombasa, Kenya
  8. 8Department of Gynecologic Oncology, Caucasus Medical Centre, Tbilisi, Georgia
  9. 9Department of Surgery, David Tvildiani Medical University, Tbilisi, Georgia
  10. 10Department of Nuclear Medicine, Hospital Clinic de Barcelona, Barcelona, Spain
  11. 11Department of Obstetrics and Gynecology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu, Taiwan
  12. 12Division of Cancer Sciences, The University of Manchester, Manchester, UK
  13. 13Department of Obstetrics and Gynecology, Houston Methodist Hospital, Houston, Texas, USA
  1. Correspondence to Dr Nuria Agusti, Department of Gynecologic Oncology and Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, USA; NAgusti{at}


Epithelial ovarian cancer most commonly presents at advanced stages, and prognosis is influenced by residual disease following cytoreduction. The significance of cardiophrenic lymph node resection at the time of cytoreductive surgery in advanced ovarian cancer remains a topic of debate. Enlarged cardiophrenic lymph nodes are detected through high-resolution imaging; however, the optimal imaging technique in determining feasibility of node resection remains uncertain. Similarly, the impact of excision of cardiophrenic lymph nodes on progression-free and overall survival remains elusive. The indications for resection of cardiophrenic lymph nodes are not addressed in standard ovarian cancer guidelines. Patients with cardiophrenic lymph nodes exceeding 1 cm in size may be considered for resection if complete intra-abdominal cytoreduction is feasible to no gross residual. The surgical approach might be either by open access or by video-assisted thoracoscopic surgery (minimally invasive approach), and major complications following cardiophrenic lymph nodes resection are low. Pathological cardiophrenic lymph nodes are associated with a poorer overall prognosis and can serve as a prognostic parameter; however, the therapeutic benefit of cardiophrenic lymph nodes resection remains inconclusive.

  • Ovarian Neoplasms
  • Surgical Oncology
  • Lymphatic Metastasis

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  • NA and GB are joint first authors.

  • Twitter @BonaldoGiulio, @nissiemburu, @gvantsagk, @HsuMd, @JenOG, @pedroramirezMD

  • Contributors NA contributed to conceptualizing the study, methodology, and contributed to preparing the original manuscript and editing. GB, RK, AR, TLP, AM, GK, and J-CD contributed to conceptualizing the study and to preparing the original manuscript and editing. DN, PP, and H-CH contributed to conceptualizing the study. PTR contributed to conceptualizing the study, consulted for clinical expertise, reviewed the data, and contributed to editing the manuscript. J-CD, PTR contributed equally and should be considered last authors.

  • 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.

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