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Deep epigastric lymph node involvement in patients with ovarian and colorectal peritoneal metastasis: A prospective
Antoine El Asmar1, Charif Khaled1, Isabelle Veys1
1Department of Surgery, Jules Bordet Institute, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
Background:
The inferior deep epigastric lymph node basin has been described as a lymphatic pathway for systemic cancer dissemination from the intra-abdominal cavity. This study aimed to determine the incidence and conditions of involvement of this basin in patients with peritoneal metastases of ovarian and colorectal cancer.
Methods:
This single-center prospective pilot trial conducted over 3 years (from December 10, 2020, to September 1, 2023) included patients with peritoneal metastases of ovarian and colorectal cancer presenting for cytoreductive surgery. For each patient, bilateral inferior deep epigastric lymph node harvesting and histologic analysis was performed.
Results:
This study enrolled 40 patients, 20 with peritoneal metastases of ovarian cancer and 20 with peritoneal metastases of colorectal cancer. Of the 20 patients with peritoneal metastases of ovarian cancer, 6 (30%) had positive inferior deep epigastric lymph nodes, including 5 with high peritoneal cancer index (31, 28, 25, 17, 16). Of the patients with peritoneal metastases of colorectal cancer, 2 had positive inferior deep epigastric lymph nodes (10%) with peritoneal cancer index of 25 and 15, respectively.
Conclusion:
The inferior deep epigastric lymph node basin represents a drainage route for the peritoneum and provided an alternative pathway for systemic dissemination in 30% of patients with peritoneal metastases of ovarian cancer and 10% of patients with peritoneal metastases of colorectal cancer. Inferior deep epigastric lymph nodes were positive in patients with high-grade disease, high peritoneal cancer index, and extensive pelvic peritoneal disease.
