Surgery

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.

Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy in peritoneal sarcomatosis: Therapeutic advancement or clinical controversy? An institutional review

Peritoneal sarcomatosis is a rare and aggressive condition with limited treatment options. Cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy has been explored as a potential therapeutic strategy, although its efficacy remains uncertain. We conducted a retrospective analysis of 24 patients with peritoneal sarcomatosis secondary to uterine and retroperitoneal sarcomas treated at a tertiary oncology center in India between 2014 and 2020. Eligible patients underwent cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy, with follow-up extending for at least 5 years. Outcomes assessed included completeness of cytoreduction (CC-0/1), perioperative morbidity, overall survival, and progression-free survival. The cohort comprised patients with 16 uterine sarcoma and 8 patients with retroperitoneal sarcoma. Complete cytoreduction (CC-0/1) was achieved in 92% of cases. The median overall survival was 35 months (uterine: 32 months; retroperitoneal: 38 months), with 1-, 3-, and 5-year survival rates of 75%, 50%, and 30%, respectively. The median progression-free survival was 14 months, with a recurrence rate of 67%. Postoperative complications occurred in 17%, with no 30-day mortality. Cytoreductive surgery with hyperthermic intraperitoneal chemotherapy offers a potential survival benefit for select patients with peritoneal sarcomatosis, particularly those with complete cytoreduction. Although recurrence rates remain high, this approach may improve outcomes compared with systemic therapy alone. Further prospective studies are needed to refine patient selection and optimize treatment strategies.