The clinicopathological parameters that could be identified pre- or intra-operatively to decide the indication for PAND were compared between patients with and without PAN metastasis.
Next, the association between the histological status of 17 regional lymph node stations and the proportion of PAN metastatis were evaluated with odds ratio. Two-sided P values were calculated and are presented.
Statistical analysis was performed using SAS version 8. In order to validate reproducibility of the predictive factors detected in this prospective study, we analyzed a retrospectively collected data set consisting of patients who had undergone gastrectomy with PAND at Osaka Medical College between and The patients ranged in age from 27 to 75 years mean age, In 47 of the patients, the tumor was located in the upper third of the stomach, while it was in the middle third in and the lower third in Total gastrectomy was performed in 97 patients, distal gastrectomy in , and proximal gastrectomy in three.
PAN metastasis was histologically found in 22 8. The association between the possible risk factors and PAN metastasis is shown in Table 2. After adjustment of other variables, macroscopic N stage and tumor size showed statistically significant association. There were no significant associations in sex, body mass index, macroscopic tumor type, tumor location or macroscopic T stage.
Association between clinicopathological factors and histological metastasis of para-aortic lymph nodes PAN. Proportion of histological metastasis of para-aortic lymph nodes PAN stratified with macroscopic N stages. We next examined the associations between the histological status of 17 regional lymph node stations and PAN metastasis Table 4. Most nodal stations except for those along the greater curvature of the stomach No.
Among those 12 stations, No. When we entered the histological status of all N1 or N2 stations to the multivariate logistic regression model, any stations except No. Station No.
When we used the histological status of station No. Association between histological metastasis of 17 regional lymph node stations and that of para-aortic lymph nodes PAN. In the present study, the incidence of PAN metastasis was significantly higher in patients with undifferentiated tumor, large tumor and tumor with macroscopic N2—4.
Similar results have been reported in retrospective studies by other researchers 15 , Only one tumor smaller than 5 cm had PAN metastasis, while The results were reproduced in an independent validation dataset. As for the regional lymph node status, most of them were associated with PAN metastasis but station No.
The diagnostic sensitivity and specificity of station No. Although station No. It might be due to the high correlation between No. Actually, all six cases with metastases in both station No. This result indicated that the pathological status of No.
Another explanation is that metastatic cancer cells that left No. Or else, while the No. This finding also helps us to study the pattern of lymphatic flow to the nodes surrounding the abdominal aorta. Such anatomical study of the lymphatic system shows that a higher number of nodes than expected can be found in the retroperitoneum.
Abstract Between January and June , systematic para-aortic and pelvic lymphadenectomy was performed in women with untreated ovarian, endometrial, and cervical cancers. Regarding tumor type or origin, no significant difference was noted in right-sided compared with left-sided para-aortic metastases. Conclusions: Our data suggest no difference in the incidence of metastases to right-sided compared with left para-aortic lymph nodes in patients with gynecologic malignancies, emphasizing the need for bilateral evaluation of the para-aortic lymph nodes.
There were no patients with isolated supra-renal PAN metastasis Table 2. It was found that all patients with supra-renal PAN metastasis also had multiple metastases to the infra-renal PANs and PLNs, but there were no correlations between metastases at particular sites Table 3.
In 11 patients with advanced cancer, differences of background factors and perioperative factors were evaluated between the 4 patients who were positive for supra-renal PAN metastasis and the 7 patients who were negative for such metastasis, but no significant differences were found data not shown. With regard to the feasibility of performing extended para-aortic lymph node dissection, the median operating time was 6.
Similarly, hypertension and proteinuria were noted as adverse events due to the bevacizumab component of NAC that persisted after surgery Table 4. 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. A total of 25 patients were investigated, including 11 with advanced cancer, so the data are only preliminary because the number of subjects was small.
Our findings suggested that supra-renal PANs might be considered as distant lymph nodes rather than regional lymph nodes because none of the patients with early cancer had supra-renal PAN metastasis, while such metastasis was only observed in some of the patients with advanced cancer, all of whom also had widespread multiple metastases to other nodes. There have already been many reports about infra-renal PAN metastasis in patients with epithelial ovarian cancer. A systematic review of 14 articles showed that 7.
In addition, the incidence rate of infra-renal PAN metastasis was reported to be In the present study, infra-renal PAN metastasis was observed in 1 out of 14 patients with T1 and T2 cancer 7.
Although the number of subjects was small, our patients seemed to be a typical population with ovarian cancer. However, we actively performed NAC at our institution, so a high proportion of the patients with advanced disease underwent IDS. Accordingly, we cannot exclude the possibility that the frequency of supra-renal PAN metastasis may have been different if a larger proportion of patients had received PDS. Therefore, it is necessary to increase the number of PDS patients drastically to investigate the frequency of supra-renal PAN metastasis in the future study.
None of our patients had isolated supra-renal PAN metastasis and none of the patients with a clinical diagnosis of early cancer had supra-renal PAN metastasis. In addition, supra-renal PAN metastasis was observed in These results suggest that the supra-renal PANs might be considered to be distant lymph nodes rather than regional lymph nodes. Regarding the feasibility of our method of extended para-aortic lymph node dissection, the operating time was slightly longer, hypoalbuminemia and anemia were frequent, but there were no serious complications, and the procedure was tolerable.
In particular, intestinal obstruction and chylous ascites were concerns in relation to this operation, but such events were mild and had a low frequency. However, the frequency of complications including pulmonary complications, infection, intestinal complications, thromboembolism, lymphatic complications, and blood transfusion was similar to or lower than the rates of perioperative complications reported after conventional PAN dissection [ 8 , 11 , 12 , 13 ], suggesting that the safety of extended PAN dissection was not inferior to conventional dissection and that dissecting the supra-renal PANs has little negative impact.
Because the current patient population was small, the findings of this study are limited. Accordingly, collection of more data on extended supra-renal PAN dissection in patients with ovarian cancer is required, and further studies should be conducted in a larger population to evaluate the diagnostic significance of supra-renal PAN metastasis. Although there is no doubt about the diagnostic significance of systematic PAN dissection, there have been some negative reports about its therapeutic value [ 13 , 14 ], suggesting that accumulation of more data is required to allow further discussion of this issue.
The present findings suggested that supra-renal PAN metastasis should be classified as distant rather than regional metastasis in patients with epithelial ovarian cancer. The data and materials in the current study are available from the corresponding author on reasonable request. Classification of regional lymph nodes in Japan. Int J Clin Oncol ; Staging classification for cancer of the ovary, fallopian tube, and peritoneum.
Int J Gynaecol Obstet ; Gynecol Oncol. Article Google Scholar. Lymph node metastasis in stages I and II ovarian cancer: a review. Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials.
J Clin Oncol. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer. Ann Surg Oncol. J Gynecol Oncol.
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