Abstract
BackgroundIn patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer.MethodsThe subjects were 25 patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer who underwent systematic dissection of the para-aortic nodes, including the supra-renal PAN, and pelvic lymph nodes (PLN). Patient factors, perioperative factors, the number of dissected lymph nodes, and pathological lymph node metastasis were investigated.ResultsSupra-renal PAN metastasis was found in 4/25 patients (16.0%). None of the 14 patients with pT1 or pT2 disease had supra-renal PAN metastasis, while 4/11 patients (36.4%) with pT3 or ypT3 disease had such metastases. None of the patients had isolated supra-renal PAN metastasis, while patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PAN and PLN.ConclusionsIn patients with epithelial ovarian cancer, supra-renal PAN metastases might be considered to be distant rather than regional metastases. Further studies are needed to better define the clinical significance of supra-renal PAN metastasis.
Highlights
The para-aortic lymph nodes (PANs) are located around the abdominal aorta and inferior vena cava and are the regional lymph nodes of the intraperitoneal organs
According to the International Federation of Gynecology and Obstetrics (FIGO) staging classification, the suprarenal PANs are classified as regional lymph nodes, but it is stated that there is controversy regarding whether supra-renal PAN metastasis should be considered as regional lymph node metastasis or distant metastasis, and this issue should be investigated further in the future [2]
This was the first study to evaluate the actual pattern of metastasis to the para-aortic lymph nodes (PANs) located cephalad to the renal veins in patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer
Summary
The para-aortic lymph nodes (PANs) are located around the abdominal aorta and inferior vena cava and are the regional lymph nodes of the intraperitoneal organs. In patients with epithelial ovarian cancer, primary peritoneal cancer, or fallopian tube cancer, the clinical implications of supra-renal PAN metastasis are unclear. The chief reason why the Komiyama et al World Journal of Surgical Oncology (2020) 18:64 clinical significance of supra-renal PAN metastasis remains unclear in patients with epithelial ovarian cancer, including primary peritoneal cancer and fallopian tube cancer, is that metastasis to these nodes has received little attention in the past. In patients with epithelial ovarian cancer, whether metastasis to para-aortic lymph nodes located cephalad to the renal veins (supra-renal PAN) should be classified as regional lymph node metastasis or distant metastasis remains controversial. This study was a preliminary retrospective evaluation of the pattern of supra-renal PAN metastasis in patients with epithelial ovarian cancer
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