Highlights
-
•
Cardiophrenic lymph node resection.
-
•
Advanced ovarian cancer.
-
•
Cytoreductive surgery.
Keywords: Right upper quadrant, Cardiophrenic lymph node, Debulking surgery
Abstract
Upfront debulking surgery followed by adjuvant chemotherapy still remains as the mainstay approach to patients with advanced ovarian cancer (Eisenhauer et al., 2006).
Upper abdominal surgery is often required to achieve complete gross resection and there are several studies in the literature reporting increased survival, as well as a minimal but acceptable increase in morbidity, as a result of this shift in the surgical paradigm (Chi et al., 2009).
Cardiophrenic lymph nodes (CPLNs), also referred to as paracardiac and supradiaphragmatic lymph nodes, are located just above the diaphragm. In diseases such as advanced ovarian cancer, where there is often considerable abdominal and peritoneal tumor burden, these lymph nodes can harbor metastases. These nodes are usually larger than 5 mm in diameter and are easily identified on computed tomography.
Evidence suggests that this finding should not preclude primary debulking surgery (if resectable disease in the abdomen) as it is associated with an increased median overall survival even in stage IV disease (Cowan et al., 2017, Prader et al., 2016).
We present a video highlighting one of the most commonly performed debulking procedures in the upper abdomen – right diaphragmatic peritoneal stripping (the patient had multiple small implants in both the diaphragmatic peritoneum and Morisońs Pouch peritoneum, so en bloc resection was performed) – followed by a transabdominal excision of an enlarged right cardiophrenic lymph node. The defect was closed with a 2-0 polypropylene running suture.
1. Consent
Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal on request.
CRediT authorship contribution statement
Joao Casanova: Conceptualization, Supervision, Data curation, Formal analysis, Writing - original draft, Writing - review & editing. José Filipe Cunha: Conceptualization, Data curation, Formal analysis, Writing - review & editing.
Declaration of Competing Interest
The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
Footnotes
Supplementary data to this article can be found online at https://doi.org/10.1016/j.gore.2021.100781.
Appendix A. Supplementary data
The following are the Supplementary data to this article:
References
- Cowan R.A. Feasibility, safety and clinical outcomes of cardiophrenic lymph node resection in advanced ovarian cancer. Gynecol. Oncol. 2017;147:262–266. doi: 10.1016/j.ygyno.2017.09.001. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Eisenhauer E.L. The addition of extensive upper abdominal surgery to achieve optimal cytoreduction improves survival in patients with stages IIIC-IV epithelial ovarian cancer. Gynecol. Oncol. 2006;103:1083–1090. doi: 10.1016/j.ygyno.2006.06.028. [DOI] [PubMed] [Google Scholar]
- Chi D.S. Improved progression-free and overall survival in advanced ovarian cancer as a result of a change in surgical paradigm. Gynecol. Oncol. 2009;114:26–31. doi: 10.1016/j.ygyno.2009.03.018. [DOI] [PubMed] [Google Scholar]
- Prader S.P. Surgical management of cardiophrenic lymph nodes in patients with advanced ovarian cancer. Gynecol. Oncol. 2016;141:271–275. doi: 10.1016/j.ygyno.2016.03.012. [DOI] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.