Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer

Roberto Berretta, Vito Andrea Capozzi, Giulio Sozzi, Lavinia Volpi, Valentina Ceni, Mauro Melpignano, Giovanna Giordano, Federico Marchesi, Michela Monica, Maurizio Di Serio, Matteo Riccò, Marcello Ceccaroni

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Abstract

PURPOSE: The aim of this retrospective study is to analyze the prognostic role and the practical implication of mesenteric lymph nodes (MLN) involvements in advanced ovarian cancer (AOC).

METHODS: A total of 429 patients with AOC underwent surgery between December 2007 and May 2017. We included in the study 83 patients who had primary (PDS) or interval debulking surgery (IDS) for AOC with bowel resection. Numbers, characteristics and surgical implication of MLN involvement were considered.

RESULTS: Eighty-three patients were submitted to bowel resection during cytoreduction for AOC. Sixty-seven patients (80.7%) underwent primary debulking surgery (PDS). Sixteen patients (19.3%) experienced interval debulking surgery (IDS). 43 cases (51.8%) showed MLN involvement. A statistic correlation between positive MLN and pelvic lymph nodes (PLN) (p = 0.084), aortic lymph nodes (ALN) (p = 0.008) and bowel infiltration deeper than serosa (p = 0.043) was found. A longer overall survival (OS) and disease-free survival was observed in case of negative MLN in the first 20 months of follow-up. No statistical differences between positive and negative MLN in terms of operative complication, morbidity, Ca-125, type of surgery (radical vs supra-radical), length and site of bowel resection, residual disease and site of recurrence were observed.

CONCLUSIONS: An important correlation between positive MLN, ALN and PLN was detected; these results suggest a lymphatic spread of epithelial AOC similar to that of primary bowel cancer. The absence of residual disease after surgery is an independent prognostic factor; to achieve this result should be recommended a radical bowel resection during debulking surgery for AOC with bowel involvement.

Original languageEnglish
Pages (from-to)997-1004
Number of pages8
JournalArchives of Gynecology and Obstetrics
Volume297
Issue number4
DOIs
Publication statusPublished - Apr 2018

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Berretta, R., Capozzi, V. A., Sozzi, G., Volpi, L., Ceni, V., Melpignano, M., Giordano, G., Marchesi, F., Monica, M., Di Serio, M., Riccò, M., & Ceccaroni, M. (2018). Prognostic role of mesenteric lymph nodes involvement in patients undergoing posterior pelvic exenteration during radical or supra-radical surgery for advanced ovarian cancer. Archives of Gynecology and Obstetrics, 297(4), 997-1004. https://doi.org/10.1007/s00404-018-4675-y