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Metastatic peripancreatic lymph nodes resection during primary debulking surgery for primary peritoneal serous carcinoma

      Highlights

      • Ovarian, fallopian tube, and primary peritoneal cancer sometimes metastasize to the peripancreatic lymph nodes.
      • An anatomic variant of the common hepatic artery was identified.
      • We completely resected the peripancreatic lymph nodes without injuring the hepatic artery, portal vein, or common bile duct.

      Abstract

      Objective

      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.

      Methods

      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.

      Results

      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).

      Conclusion

      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.

      Keywords

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      Reference

        • Japan Pancreas Society
        Classification of Pancreatic Carcinoma.
        2nd English edition. Kanehara & Co. Ltd, Tokyo2003