Inferior epigastric artery lymph nodes: A pathway for systemic dissemination from peritoneal carcinomatosis?
abdominal metastatic pathways
deep inferior epigastric lymph nodes
peritoneal carcinomatosis
retroperitoneal lymphatic channels
Journal
Journal of surgical oncology
ISSN: 1096-9098
Titre abrégé: J Surg Oncol
Pays: United States
ID NLM: 0222643
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
03
09
2020
revised:
23
09
2020
accepted:
09
10
2020
pubmed:
31
10
2020
medline:
12
1
2021
entrez:
30
10
2020
Statut:
ppublish
Résumé
We 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. In 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. In 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. These 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.
Sections du résumé
BACKGROUND AND OBJECTIVES
OBJECTIVE
We 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 METHODS
METHODS
In 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.
RESULTS
RESULTS
In 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.
CONCLUSION
CONCLUSIONS
These 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.
Substances chimiques
Indocyanine Green
IX6J1063HV
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
311-314Informations de copyright
© 2020 Wiley Periodicals LLC.
Références
Narasimhan V, Britto M, Pham T, et al. Evolution of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy for colorectal peritoneal metastases. Dis Colon Rectum. 2019;62(10):1195-1203.
Bijelic L, Yan TD, Sugarbaker PH. Failure analysis of recurrent disease following complete cytoreduction and perioperative intraperitoneal chemotherapy in patients with peritoneal carcinomatosis from colorectal cancer. Ann Surg Oncol. 2007;14(8):2281-2288.
Swartz MA, Skobe M. Lymphatic function, lymphangiogenesis, and cancer metastasis. Microsc Res Tech. 2001;55(2):92-99.
Krishnamurthy R, Hernandez A, Kavuk S, Annam A, Pimpalwar S, Pimpalwar S. Imaging the central conducting lymphatics: initial experience with dynamic MR lymphangiography. Radiology. 2015;274(3):871-878.
Elias D, Borget I, Farron M, et al. Prognostic significance of visible cardiophrenic angle lymph nodes in the presence of peritoneal metastases from colorectal cancers. Eur J Surg Oncol. 2013;39(11):1214-1218.
Shibata S, Yamaguchi S, Kaseda M, Ichihara N, Hayakawa T, Asari M. The time course of lymphatic routes emanating from the peritoneal cavity in rats. Anat Histol Embryol. 2007;36(1):78-82.
Parungo CP, Soybel DI, Colson YL, et al. Lymphatic drainage of the peritoneal space: a pattern dependent on bowel lymphatics. Ann Surg Oncol. 2007;14(2):286-298.
Ochoa O, Metzner M, Theoharis C, et al. Deep inferior epigastric lymph node basin: analysis of novel donor site for vascularized lymph node transfer among 10 consecutive patients. Microsurgery. 2019;39(3):215-220.
Liberale G, Vankerckhove S, Galdon MG, Donckier V, Larsimont D, Bourgeois P. Fluorescence imaging after intraoperative intravenous injection of indocyanine green for detection of lymph node metastases in colorectal cancer. Eur J Surg Oncol. 2015;41(9):1256-1260.
Caramella C, Pottier E, Borget I, et al. Value of cardiophrenic angle lymph node for the diagnosis of colorectal peritoneal carcinomatosis. Eur J Cancer. 2013;49(18):3798-3805.
Noncoronary/Noncardiac Lesions-ClinicalKey. https://www-clinicalkey-com.ezsecureaccess.balamand.edu.lb/#!/content/book/3-s2.0-B9781437704075000300?scrollTo=%23hl0000747. Accessed May 19, 2020.
Li L, Zhang H, Wang L, Xie C, Zhou Y, Zhong Y. A retrospective analysis on metastatic rate of the internal mammary lymph node and its clinical significance in adjuvant radiotherapy of breast cancer patients. BMC Cancer. 2020;20(1):153.
Comprehensive trunk anatomy-ClinicalKey. https://www-clinicalkey-com.ezsecureaccess.balamand.edu.lb/#!/content/book/3-s2.0-B9780323357067000099?scrollTo=%23hl0000391. Accessed May 19, 2020.