Metastatic lymph node resection around the porta hepatis is sometimes required to
achieve complete cytoreduction for ovarian, fallopian tube, and primary peritoneal
cancer. Hence, this study aimed to present the surgical approach of peripancreatic
lymph node removal around the porta hepatis as part of primary debulking surgery.
A 75-year old woman with stage IIIC primary peritoneal serous carcinoma underwent
primary debulking surgery by means of the following procedures: bilateral salpingo-oophorectomy,
total hysterectomy, omentectomy, total pelvic peritonectomy, rectosigmoid colectomy
with anastomosis, right hemicolectomy, right diaphragm resection, partial jejunal
resection, and pelvic and para-aortic lymphadenectomy. Furthermore, she underwent
enlarged peripancreatic lymph nodes resection located in the hepatoduodenal ligament
and on the posterior pancreatic head. An anatomic variant of the common hepatic artery
was identified to be arising from the superior mesenteric artery and not from the
celiac artery. The common hepatic artery ran behind the portal vein. We resected the
lymph nodes without causing injury of the hepatic artery, portal vein, and common
bile duct and achieved complete cytoreduction.
The histological examination revealed high-grade serous carcinoma in three of nine
resected peripancreatic lymph nodes. In contrast, only one lymph node metastasized
in the interaortocaval region among the 63 resected regional lymph nodes (paraaortic
and pelvic lymph nodes).
Metastatic peripancreatic lymph nodes resection around the porta hepatis is feasible
and sometimes necessary for cytoreductive surgery for advanced ovarian, fallopian
tube, and primary peritoneal cancer.