Mesenteric lymph nodes involvement in advanced ovarian cancer patients after debulking surgery

Purpose : In literature only few studies investigated the role of mesenteric lymph nodes in the context of bowel resection during cytoreductive surgery for ovarian cancer (OC). Despite the lack of a consensus regarding the best surgical approach, data showed connection between depth of bowel infiltration, rectosigmoid lymph-vascular space infiltration with mesenteric lymph nodes involvement. This study investigates the incidence of mesenteric lymph nodes involvement in patients undergoing bowel resection during debulking surgery in advanced OC and its correlation with pathological factors. Methods : This is a retrospective study collecting data from November 2018 to August 2022 in two Italian Institutions (IRCCS San Raffaele Hospital, Vita e Salute University Milan and Policlinico Monserrato, University of Cagliari). OC patients undergoing rectosigmoid resection during primary debulking surgery or interval debulking surgery were recorded. The characteristics of mesenteric node involvement were evaluated. Results : Mesenteric lymph nodes were detected in 38/67 cases (57%); involvement rate was 53%. Metastatic mesenteric lymph nodes were associated with depth of bowel infiltration (p = 0.009). Significant correlation between positive mesenteric lymph nodes and pelvic lymph nodes (p = 0.022), aortic lymph nodes (p = 0.005) was found. No association was found between mesenteric lymph nodes involvement and pattern of relapse. BRCA status did not affect mesenteric lymph nodes involvement. Conclusion : OC patients undergoing rectosigmoid resection during debulking surgery revealed metastatic mesenteric lymph nodes involvement in 53% of cases. This finding was related to a deeper infiltration of the bowel, rectosigmoid lymph-vascular space infiltration, pelvic and aortic lymph nodes metastases.