Ovarian cancer and isolated cardiophrenic lymph nodes metastases: a systematic review

Currently, there is limited information available on the best course of action for advanced epithelial ovarian cancer (OC) with isolated extra-peritoneal disease in the cardiophrenic lymph nodes. Recently, there have been numerous reports of successful surgical removal of metastatic cardiophrenic lymph nodes in patients with OC, mostly during primary or interval cytoreduction procedures. However, the optimal management of isolated, extra-peritoneal cardiophrenic lymph node metastasis (ICLNM) remains unclear, since this clinical scenario is rather uncommon in OC and chemotherapy is so far the indicated treatment for patients with from advanced stage disease. We searched the English-language literature for cases of OC with ICLNM or recurrence, evaluating the feasibility and safety of surgical excision. From 2009 to 2022 only 11 cases were reported. In seven the tumor was of serous histology. ICLN was detected in five cases with primary disease and in the remaining six it was recurrence of OC. The primary disease was treated in 10/11 patients with primary cytoreduction while the other received systemic chemotherapy. The ICLNM was removed in all the patients, in 10 via video-assisted thoracic surgery and in one via transdiaphragmatic incision. Median follow-up was 10 months.