Transabdominal cardiophrenic lymph node dissection for cytoreductive surgery in advanced ovarian cancer

Hee Chul Yang 1, Sang-Yoon Park 2, Jin Ho Choi 1, Moon Soo Kim 1, Jong Mog Lee 1

1 Department of Thoracic Surgery, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea 2 Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea

Purpose : Ovarian cancer is mainly diagnosed at an advanced stage with peritoneal seeding. Minimizing residual tumor is one of the most important prognostic factors in the management of advanced ovarian cancer. Although the cardiophrenic lymph node (CPLN) metastases are uncommon, the optimal surgical approach remains unclear. This video will show the feasibility of the transabdominal approach instead of the VATS approach.



Methods : A 60-year-old woman presented with suspicious bilateral ovarian cancer. Preoperative CT demonstrated peritoneal seeding and multiple lymph nodes metastases including the right anterior, lateral, posterior, and left anterior CPLN.

Results : The gynecology and general surgery team underwent a hysterectomy, bilateral salpingo-oophorectomy, low anterior resection, peritonectomy, appendectomy, and pelvic LN dissection via laparotomy. The thoracic surgeon took over the operation because the pelvic cavity was regarded as R0 resection. Transabdominal CPLN dissection was performed through subxiphoid plane dissection. The bilateral phrenic nerves were well-preserved and there was no postoperative complication. A follow-up CT scan showed no residual CPLN.

Conclusion : The surgical technique of transabdominal CPLN dissection while minimizing the diaphragm injury is strongly recommended. A thoracic surgeon could play an important role in this field.

책임저자: Hee Chul Yang

Department of Thoracic Surgery, National Cancer Center, Goyang, Republic of Korea

발표자: Hee Chul Yang, E-mail : pda1052@gmail.com