Gabriel Liberale

Deep epigastric lymph node involvement in patients with ovarian and colorectal peritoneal metastasis: A prospective pilot study

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. 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. 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. 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.

Assessment of the American College of Surgeons Surgical Risk Calculator (ACS-SRC) for Prediction of Early Postoperative Complications in Patients Undergoing Cytoreductive Surgery for Ovarian Peritoneal Carcinomatosis

Ovarian cancer (OC) is diagnosed at a locally advanced stage in two-thirds of cases. The first line of treatment consists of cytoreductive surgery (CRS) combined with neoadjuvant and/or adjuvant chemotherapy. However, CRS can be associated with high rates of postoperative complications (POCs), and detection of fragile patients at high risk of POCs is important. The American College of Surgeons Surgical Risk Calculator (ACS-SRC) provides a predictive model for early POCs (30 days) for any given surgical procedure. This study aimed to evaluate the performance of the ACS-SRC in predicting the occurrence of early POCs for patients undergoing CRS for OC. This was a retrospective study that included patients undergoing CRS for advanced OC between January 2010 and December 2022. Early POCs were reviewed, and the rate of POCs was compared with those predicted by the ACS-SRC to evaluate its accuracy (i.e., discrimination and calibration). A total of 218 patients were included, 112 of whom underwent extensive surgery/resection. A total of 94 complications were recorded. This cohort demonstrated correct calibration of the ACS-SRC for the prediction of surgical site infection, readmission, and the need for nursing care post-discharge (NCPD; transfer to revalidation center or need for nursing care at home). Using both the discrimination and calibration methods, the score only predicted NCPD. In this study, the ACS-SRC was shown to be of little value for patients undergoing cytoreductive surgery for ovarian peritoneal carcinomatosis, as it only accurately predicted NCPD.

Inferior epigastric artery lymph nodes: A pathway for systemic dissemination from peritoneal carcinomatosis?

AbstractBackground and ObjectivesWe report, for the first time in the literature, a metastatic lymphatic pathway along the inferior epigastric vessels, through the inferior epigastric lymph nodes (IELNs), in patients with peritoneal carcinomatosis (PC). Interestingly, these lymph nodes (LNs) in the anterior retroperitoneum were not detectable on preoperative imaging. They may, however, represent a pertinent systemic dissemination pathway for PC.Patients and MethodsIn patients undergoing indocyanine green‐fluorescence imaging during cytoreductive surgery for PC, an incidental finding of a hyperfluorescent LN, harboring metastatic tumorous cells, around the inferior epigastric artery was made.ResultsIn three out of five patients with clear fluorescent hotspot, the harvested LN was harboring metastatic cancerous cells. None of these nodes, whether negative or positive, was visible on any preoperative imaging modalities. A protocol to sample, in a systematic manner, the IELN in patients with PC, is currently being devised at our institution.ConclusionThese lymphatic nodes basin and channels might reveal to be a potential passage from peritoneal metastasis to the extraperitoneal lymphatic compartment, representing an independent pathway for cancerous cell dissemination. This will bring us to further investigate the prevalence and the prognostic significance of these LNs.