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Background/Objective <p>Cardiophrenic lymph node (CPLN) enlargement is increasingly recognized in epithelial ovarian cancer (EOC) as an indicator of extensive upper abdominal disease. However, evidence on the feasibility and perioperative safety of transdiaphragmatic CPLN dissection (CPLND) during primary cytoreduction remains limited. This study aimed to evaluate the technical feasibility, surgical characteristics, and postoperative outcomes of transdiaphragmatic CPLND in patients undergoing primary cytoreductive surgery for EOC.</p> Methods <p>This retrospective study included 15 patients with radiologically suspicious CPLNs (short-axis ≥ 7&#xa0;mm) who underwent CPLND during primary cytoreductive surgery at a single tertiary center between December 2022 and April 2025. Demographic data, tumor characteristics, surgical parameters, nodal distribution, histopathology, and 30-day postoperative complications (Clavien–Dindo classification) were analyzed.</p> Results <p>Fifteen patients were included, with a mean age of 63.2 ± 8.8&#xa0;years and BMI of 28.2 ± 3.4&#xa0;kg/m<sup>2</sup>. Twelve patients (80.0%) had FIGO stage III–IV disease. The mean CPLN diameter was 14.2 ± 3.4&#xa0;mm, and all nodes were right-sided; anterior nodes predominated (93.3%). A total mean of 4.4 ± 4.1 nodes were resected. CPLN metastasis was confirmed in 66.7% of patients. Complete macroscopic cytoreduction (R0) was achieved in 66.7%. Major complications (≥ CD III) occurred in 5 patients (33.3%), with no perioperative mortality. Thoracic drainage was required in 66.7% for a mean of 4 ± 2&#xa0;days. Adjuvant chemotherapy was initiated within 4&#xa0;weeks in 86.7% of patients.</p> Conclusions <p>Transdiaphragmatic CPLND appears to be a feasible and safe adjunct to primary cytoreductive surgery in selected EOC patients with radiologic suspicion of supradiaphragmatic disease. Although respiratory events were common, most were managed conservatively. Careful patient selection and meticulous intraoperative technique may optimize outcomes.</p>

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Transdiaphragmatic Cardiophrenic Lymph Node Dissection in Epithelial Ovarian Cancer: Surgical Results and Clinical Safety from a Single Institution

  • 期刊论文

  • 发表日期：

    2026年3月4日

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  • Candost Hanedan,
  • Oğuz Kaan Köksal,
  • Neslihan Öztürk,
  • Şahin Kaan Baydemir,
  • Hande Nur Öncü,
  • Vakkas Korkmaz

摘要

Background/Objective

Cardiophrenic lymph node (CPLN) enlargement is increasingly recognized in epithelial ovarian cancer (EOC) as an indicator of extensive upper abdominal disease. However, evidence on the feasibility and perioperative safety of transdiaphragmatic CPLN dissection (CPLND) during primary cytoreduction remains limited. This study aimed to evaluate the technical feasibility, surgical characteristics, and postoperative outcomes of transdiaphragmatic CPLND in patients undergoing primary cytoreductive surgery for EOC.

Methods

This retrospective study included 15 patients with radiologically suspicious CPLNs (short-axis ≥ 7 mm) who underwent CPLND during primary cytoreductive surgery at a single tertiary center between December 2022 and April 2025. Demographic data, tumor characteristics, surgical parameters, nodal distribution, histopathology, and 30-day postoperative complications (Clavien–Dindo classification) were analyzed.

Results

Fifteen patients were included, with a mean age of 63.2 ± 8.8 years and BMI of 28.2 ± 3.4 kg/m2. Twelve patients (80.0%) had FIGO stage III–IV disease. The mean CPLN diameter was 14.2 ± 3.4 mm, and all nodes were right-sided; anterior nodes predominated (93.3%). A total mean of 4.4 ± 4.1 nodes were resected. CPLN metastasis was confirmed in 66.7% of patients. Complete macroscopic cytoreduction (R0) was achieved in 66.7%. Major complications (≥ CD III) occurred in 5 patients (33.3%), with no perioperative mortality. Thoracic drainage was required in 66.7% for a mean of 4 ± 2 days. Adjuvant chemotherapy was initiated within 4 weeks in 86.7% of patients.

Conclusions

Transdiaphragmatic CPLND appears to be a feasible and safe adjunct to primary cytoreductive surgery in selected EOC patients with radiologic suspicion of supradiaphragmatic disease. Although respiratory events were common, most were managed conservatively. Careful patient selection and meticulous intraoperative technique may optimize outcomes.