Pattern of retroperitoneal dissemination of primary peritoneum cancer: Basis for rational use of lymphadenectomy

Giovanni D. Aletti, Cecelia Powless, Jamie N Bakkum-Gamez, Timothy O. Wilson, Karl C. Podratz, William Arthur Cliby

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Introduction: The rationale for lymphadenectomy in primary peritoneal cancer (PPC) is unclear. We sought to define the pattern of lymphatic metastasis in PPC and propose evidence-based rationale for lymphadenectomy in relevant cases. Methods: Patients with PPC undergoing primary surgery at Mayo Clinic were identified. Demographics, tumor characteristics, procedures performed and follow up were analyzed. Results: Forty eight patients with PPC were identified; 39 had stage IIIC (81.2%) and 9 (18.8%) had stage IV. Residual disease (RD) after primary surgery was microscopic in 6 cases (12.5%), less than 1 cm in 33 (68.8%), more than 1 cm in 9 patient (18.7%) with median survivals of 5.8, 3.2 and 1.3 years, respectively. Overall, 24 patients had lymphadenectomy performed (pelvic (PND) or paraortic (PAND) or both). Pelvic nodes were involved in 12/23 (52.7%) cases, while para-aortic nodes were involved in 5/21 (23.8%) of cases. The rate of simultaneously positive pelvic and para-aortic nodes was 20% (4/20). Nodal involvement was a poor prognostic factor with 5 year overall survival 63% vs. 25% (p = 0.014) in node positive vs. negative cases. Compared to patients with primary ovarian cancer (OC), OC cases had a higher rate of positive para-aortic nodes (57.6%: 77/132; p = 0.004). Conclusions: Retroperitoneal lymph nodes are a common site of metastases in PPC, therefore it is logically consistent to perform PND and PAND if a patient can be cytoreduced to microscopic RD in other sites or remove grossly positive nodes in patients with RD < 1 cm.

Original languageEnglish (US)
Pages (from-to)32-36
Number of pages5
JournalGynecologic Oncology
Volume114
Issue number1
DOIs
StatePublished - Jul 2009

Fingerprint

Peritoneum
Lymph Node Excision
Neoplasms
Ovarian Neoplasms
Lymphatic Metastasis
Survival
Lymph Nodes
Demography
Neoplasm Metastasis

Keywords

  • Lymphadenectomy
  • Lymphatic dissemination
  • Ovarian carcinoma
  • Primary peritoneal carcinoma
  • Prognosis

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Pattern of retroperitoneal dissemination of primary peritoneum cancer : Basis for rational use of lymphadenectomy. / Aletti, Giovanni D.; Powless, Cecelia; Bakkum-Gamez, Jamie N; Wilson, Timothy O.; Podratz, Karl C.; Cliby, William Arthur.

In: Gynecologic Oncology, Vol. 114, No. 1, 07.2009, p. 32-36.

Research output: Contribution to journalArticle

Aletti, Giovanni D. ; Powless, Cecelia ; Bakkum-Gamez, Jamie N ; Wilson, Timothy O. ; Podratz, Karl C. ; Cliby, William Arthur. / Pattern of retroperitoneal dissemination of primary peritoneum cancer : Basis for rational use of lymphadenectomy. In: Gynecologic Oncology. 2009 ; Vol. 114, No. 1. pp. 32-36.
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abstract = "Introduction: The rationale for lymphadenectomy in primary peritoneal cancer (PPC) is unclear. We sought to define the pattern of lymphatic metastasis in PPC and propose evidence-based rationale for lymphadenectomy in relevant cases. Methods: Patients with PPC undergoing primary surgery at Mayo Clinic were identified. Demographics, tumor characteristics, procedures performed and follow up were analyzed. Results: Forty eight patients with PPC were identified; 39 had stage IIIC (81.2{\%}) and 9 (18.8{\%}) had stage IV. Residual disease (RD) after primary surgery was microscopic in 6 cases (12.5{\%}), less than 1 cm in 33 (68.8{\%}), more than 1 cm in 9 patient (18.7{\%}) with median survivals of 5.8, 3.2 and 1.3 years, respectively. Overall, 24 patients had lymphadenectomy performed (pelvic (PND) or paraortic (PAND) or both). Pelvic nodes were involved in 12/23 (52.7{\%}) cases, while para-aortic nodes were involved in 5/21 (23.8{\%}) of cases. The rate of simultaneously positive pelvic and para-aortic nodes was 20{\%} (4/20). Nodal involvement was a poor prognostic factor with 5 year overall survival 63{\%} vs. 25{\%} (p = 0.014) in node positive vs. negative cases. Compared to patients with primary ovarian cancer (OC), OC cases had a higher rate of positive para-aortic nodes (57.6{\%}: 77/132; p = 0.004). Conclusions: Retroperitoneal lymph nodes are a common site of metastases in PPC, therefore it is logically consistent to perform PND and PAND if a patient can be cytoreduced to microscopic RD in other sites or remove grossly positive nodes in patients with RD < 1 cm.",
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AU - Powless, Cecelia

AU - Bakkum-Gamez, Jamie N

AU - Wilson, Timothy O.

AU - Podratz, Karl C.

AU - Cliby, William Arthur

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AB - Introduction: The rationale for lymphadenectomy in primary peritoneal cancer (PPC) is unclear. We sought to define the pattern of lymphatic metastasis in PPC and propose evidence-based rationale for lymphadenectomy in relevant cases. Methods: Patients with PPC undergoing primary surgery at Mayo Clinic were identified. Demographics, tumor characteristics, procedures performed and follow up were analyzed. Results: Forty eight patients with PPC were identified; 39 had stage IIIC (81.2%) and 9 (18.8%) had stage IV. Residual disease (RD) after primary surgery was microscopic in 6 cases (12.5%), less than 1 cm in 33 (68.8%), more than 1 cm in 9 patient (18.7%) with median survivals of 5.8, 3.2 and 1.3 years, respectively. Overall, 24 patients had lymphadenectomy performed (pelvic (PND) or paraortic (PAND) or both). Pelvic nodes were involved in 12/23 (52.7%) cases, while para-aortic nodes were involved in 5/21 (23.8%) of cases. The rate of simultaneously positive pelvic and para-aortic nodes was 20% (4/20). Nodal involvement was a poor prognostic factor with 5 year overall survival 63% vs. 25% (p = 0.014) in node positive vs. negative cases. Compared to patients with primary ovarian cancer (OC), OC cases had a higher rate of positive para-aortic nodes (57.6%: 77/132; p = 0.004). Conclusions: Retroperitoneal lymph nodes are a common site of metastases in PPC, therefore it is logically consistent to perform PND and PAND if a patient can be cytoreduced to microscopic RD in other sites or remove grossly positive nodes in patients with RD < 1 cm.

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KW - Lymphatic dissemination

KW - Ovarian carcinoma

KW - Primary peritoneal carcinoma

KW - Prognosis

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