title: Surgical management of mesenteric lymph node metastasis in patients undergoing rectosigmoid colectomy for locally advanced ovarian carcinoma.
abstract: BACKGROUND
  We sought to determine the incidence of mesenteric lymph node metastases in patients undergoing rectosigmoid resection for epithelial ovarian carcinoma and to evaluate the potential contribution of sigmoid mesocolectomy toward achieving complete surgical cytoreduction.
  
  
  METHODS
  Pathology results for patients undergoing rectosigmoid colectomy for epithelial ovarian carcinoma from August 1998 through September 2005 were retrospectively reviewed. Fifty-three patients with pathological documentation of mesenteric lymph nodes were selected for further review. A focused analysis was performed on cases with an adequate surgical sampling of mesenteric lymph nodes (more than one positive or five total mesenteric lymph nodes) to determine the overall incidence of nodal metastases. Chi2 analysis was used to identify clinicopathologic factors associated with mesenteric lymphatic spread.
  
  
  RESULTS
  A total of 39 (73.6%) of 53 patients had an adequate mesenteric resection suitable for nodal analysis. In this subgroup, 32 (82.1%) of 39 patients had one or more mesenteric lymph nodes containing metastatic ovarian carcinoma. Invasion beyond the serosa of the rectosigmoid colon was present in 31 (79.5%) of 39 of cases; however, increasing depth of invasion was not associated with risk of mesenteric nodal disease. In addition to bowel wall involvement, the only clinical factor that correlated with mesenteric lymph node involvement was concurrent tumor spread to retroperitoneal lymph nodes (P = .025).
  
  
  CONCLUSIONS
  Locally advanced ovarian carcinoma involving the rectosigmoid colon is associated with a high incidence of mesenteric nodal metastasis. Standard surgical technique should include a sigmoid mesocolectomy with resection of the associated lymphatic tributaries at the time of rectosigmoid colectomy if the surgical objective is complete cytoreduction of occult nodal disease.
authors: The Kelly Gynecologic Oncology Service, Department of Gynecology and Obstetrics, The Sidney Kimmel Comprehensive Cancer Center, The Johns Hopkins Medical Institutions, 600 N Wolfe St/Phipps 281, Baltimore, Maryland 21224, USA. rsalani1@jhmi.edu
authors: Ritu
authors: R
authors: Salani
authors: Teresa
authors: T
authors: Diaz-Montes
authors: Robert L
authors: RL
authors: Giuntoli
authors: Robert E
authors: RE
authors: Bristow
mesh_terms: D000328:Adult; D000368:Aged; D003082:Colectomy; D012809:Colon, Sigmoid / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008643:Mesentery; D008875:Middle Aged; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000556:secondary / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome