title: Surgical management of cardiophrenic lymph nodes in patients with advanced ovarian cancer.
abstract: Debulking surgery for advanced ovarian cancer does not routinely include opening of the thorax. Even systematic lymphadenectomy does not commonly extend to lymph nodes above the diaphragm. We evaluated the outcome of systematic resection of suspicious cardiophrenic lymph nodes detected on preoperative CT-scan in patients with advanced epithelial ovarian cancer (EOC).
  
  
  
  Single-center, prospective series of 196 consecutive patients with EOC undergoing primary debulking surgery between June 2013 and June 2015. Suspicious cardiophrenic lymph nodes were defined as ≥10mm on the short axis diagnosed in pre-operative CT-scan and were removed if intra-abdominal debulking resulted in complete resection or residual tumor <10mm and the patients' performance status allowed this additional procedure. Removal of suspicious cardiophrenic lymph nodes was performed via a trans-diaphragmatic approach.
  
  
  
  Thirty (15%) out of 196 EOC patients had radiologically suspicious cardiophrenic lymph nodes ≥10mm and complete resection or residual tumor <10mm. Twenty-seven out of the thirty patients had at least one confirmed metastatic cardiophrenic lymph node. Metastatic cardiophrenic lymph nodes were associated with extensive intra-abdominal tumor spread in the upper abdomen.
  
  
  
  Patients with suspicious cardiophrenic lymph nodes detected by preoperative CT-scan had histologically confirmed metastasis in 90% of cases. The surgical procedure is feasible without major complications if performed by experienced gyneco-oncologists. The prognostic value of this procedure should be evaluated in larger controlled studies.
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany. Electronic address: s.prader@kliniken-essen-mitte.de.
authors.forename: Sonia
authors.initials: S
authors.lastname: Prader
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany; Department of General Gynecology and Gynecologic Oncology, Gynecologic Cancer Unit - Comprehensive Cancer Center, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Wien, Austria.
authors.forename: Christoph
authors.initials: C
authors.lastname: Grimm
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Traut
authors.affiliation: Department of Radiology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Kai-Uwe
authors.initials: KU
authors.lastname: Waltering
authors.affiliation: Department of Surgery, Kliniken Essen Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Pier Francesco
authors.initials: PF
authors.lastname: Alesina
authors.affiliation: Center for Pathology, Kliniken Essen Mitte, Am Deimelsberg 34, 45276 Essen, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Heikaus
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Beyhan
authors.initials: B
authors.lastname: Ataseven
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Heitz
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Stephanie
authors.initials: S
authors.lastname: Schneider
authors.affiliation: Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung, Henricistrasse 92, 45136 Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
mesh_terms: D000328:Adult; D000368:Aged; D000077216:Carcinoma, Ovarian Epithelial; D003964:Diaphragm / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D009375:Neoplasms, Glandular and Epithelial / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010051:Ovarian Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery*; D010496:Pericardium / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: Advanced ovarian cancer; Cardiophrenic lymph nodes; Lymphadenectomy; Primary debulking surgery