Ovarian carcinoma metastases to gastrointestinal tract appear to spread like colon carcinoma: implications for surgical resection.
OBJECTIVE
To profile the incidence of mesenteric lymph node metastases in patients with ovarian carcinoma and metastases to the gastrointestinal tract in order to determine the optimal technique for surgical debulking.


METHODS
The slides and charts of all patients with ovarian carcinoma who had undergone bowel resection were retrospectively reviewed and follow-up information was obtained.


RESULTS
Of 100 separate bowel resections 44% had penetration of metastases to the muscularis, 18% had invasion through the submucosa, 4% had mucosal perforation, and two patients had clinical perforation. Fifty-five percent of all resections demonstrated lymph-vascular space invasion (LVSI). In the 33 specimens which included pathologic analysis of mesenteric lymph nodes, 79% had positive LVSI, which correlated with the presence of mesenteric lymph node metastases (P = 0.05) but not histologic grade (P = 0.20). When surgery was performed for secondary debulking, the frequency of mesenteric node metastasis was higher (P = 0.15). There was a trend for patients with positive mesenteric nodes to fail sooner (median survival, 20 months vs 32 months).


CONCLUSIONS
Because ovarian carcinoma metastases to the gastrointestinal tract are frequently associated with metastases to mesenteric lymph nodes, gynecologic oncology surgeons may wish to consider resection of the mesentery in a wedge fashion similar to current standards of resection for primary bowel carcinoma in cases in which a bowel resection is being performed with the intent to debulk to zero visible residual disease.
O'Hanlan
K A
KA
Department of Obstetrics and Gynecology, Stanford University School of Medicine, California 94305, USA.
Kargas
S
S
Schreiber
M
M
Burrs
D
D
Mallipeddi
P
P
Longacre
T
T
Hendrickson
M
M
D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007414:Intestinal Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D009361:Neoplasm Invasiveness; D010051:Ovarian Neoplasms / Q000473:pathology*; D012189:Retrospective Studies