Intraoperative Ultrasound-Guided Excision of Cardiophrenic Lymph Nodes in an Advanced Ovarian Cancer Patient

Francesca Moro, Stefano Uccella, Antonia Carla Testa, Giovanni Scambia, Anna Fagotti

Research output: Contribution to journalArticle

Abstract

Objective Ovarian cancer is commonly diagnosed at an advanced stage. Complete macroscopic eradication of the disease is associated with improved prognosis. In this setting, the surgical resection of enlarged cardiophrenic lymph nodes (CPLNs) can help to achieve cytoreduction to no gross residual disease. During surgery, CPLN removal is usually performed either via video-assisted thoracic surgery or through a large transdiaphragmatic or subxiphoid incision. In the present case, we propose the use of an intraoperative transdiaphragmatic ultrasound to confirm preoperative imaging and to obtain a precise localization of the suspicious CPLNs. Methods A 50-year-old woman without peritoneal carcinomatosis was diagnosed with bilateral ovarian cancer and enlarged inguinal, pelvic, aortic, and cardiophrenic nodes. She underwent primary debulking surgery, including radical hysterectomy, bilateral salpingo-oophorectomy, omentectomy, peritoneal biopsies, and bulky nodes resection, at the iliac, inguinal, and lumboaortic regions. Results After obtaining complete abdominal cytoreduction, an intraoperative ultrasound scan was performed. Two enlarged CPLNs were ultrasonographically visualized using a convex contact probe through a transhepatic window, and their exact location was identified. After complete mobilization of the right liver, the right diaphragm was incised, proximal to the site of the lymphadenopathies. The 2 lymph nodes were identified, grasped, and removed by transdiaphragmatic approach. Absence of other residual disease was confirmed by thoracic inspection, palpation, and by a subsequent intraoperative ultrasound control. At final histology, CPLNs were positive for infiltration of high-grade serous ovarian carcinoma. Conclusions Intraoperative transdiaphragmatic ultrasound represents a possible approach to localize suspicious CPLNs and to guide their surgical eradication.

Original languageEnglish
Pages (from-to)1672-1675
Number of pages4
JournalInternational Journal of Gynecological Cancer
Volume28
Issue number9
DOIs
Publication statusPublished - Nov 1 2018

Keywords

  • Cardiophrenic lymph nodes
  • Cytoreductive surgery
  • Intraoperative ultrasound
  • Ovarian carcinoma

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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