Prognostic significance of visible cardiophrenic angle lymph nodes in the presence of peritoneal metastases from colorectal cancers

Eur J Surg Oncol. 2013 Nov;39(11):1214-8. doi: 10.1016/j.ejso.2013.08.006. Epub 2013 Sep 14.


Background: Visible cardiophrenic angle lymph nodes (CPALN) (enlarged or not), detected on CT scan are correlated with the presence of peritoneal metastases (PM), and contribute to the diagnosis of PM in colorectal cancer patients.

Objective: To study whether visible CPALN exert a prognostic impact on survival after complete cytoreductive surgery plus hyperthermic intraperitoneal chemotherapy (CCRS + HIPEC) treating PM.

Patients and methods: From 1999 to 2010, 114 patients with colorectal cancer and PM were treated with CCRS + HIPEC. CPALN were depicted in 64% of cases. The impact of visible CPALN on survival was investigated retrospectively.

Results: The mean peritoneal cancer index (PCI) score was 9.2, 21% of the patients had presented with associated liver metastases, and 71% of the women with ovarian metastases. Median follow-up was 3.9 years. Visible CPALN had no impact on OS nor on DFS, unlike the PCI score which was unequivocably the most potent prognostic factor in the multivariate analysis.

Conclusion: Although some arguments might suggest that CPALN are malignant, paradoxically, we found that visible CPALN did not exert a positive nor a negative impact on survival after CCRS + HIPEC.

Synopsis: Visible cardiophrenic angle lymph nodes (CPALN) on CT-scan are strongly associated with the presence of peritoneal metastases. But this study demonstrates that the presence of CPALN has no prognostic impact after optimal cytoreductive surgery plus HIPEC.

Keywords: Cardiophrenic angle; Colorectal cancer; Lymph nodes; Peritoneal carcinomatosis; Prognosis.

MeSH terms

  • Adult
  • Aged
  • Antineoplastic Combined Chemotherapy Protocols / administration & dosage
  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use*
  • Camptothecin / administration & dosage
  • Camptothecin / analogs & derivatives
  • Chemotherapy, Adjuvant
  • Colorectal Neoplasms / pathology*
  • Digestive System Surgical Procedures* / adverse effects
  • Female
  • Humans
  • Hyperthermia, Induced*
  • Infusions, Parenteral
  • Irinotecan
  • Kaplan-Meier Estimate
  • Liver Neoplasms / secondary
  • Liver Neoplasms / therapy
  • Lymph Nodes / diagnostic imaging
  • Lymph Nodes / pathology*
  • Male
  • Mediastinum
  • Middle Aged
  • Multivariate Analysis
  • Organoplatinum Compounds / administration & dosage
  • Ovarian Neoplasms / secondary
  • Ovarian Neoplasms / therapy
  • Oxaliplatin
  • Peritoneal Neoplasms / diagnostic imaging
  • Peritoneal Neoplasms / mortality
  • Peritoneal Neoplasms / secondary*
  • Peritoneal Neoplasms / therapy*
  • Predictive Value of Tests
  • Prognosis
  • Retrospective Studies
  • Tomography, X-Ray Computed


  • Organoplatinum Compounds
  • Oxaliplatin
  • Irinotecan
  • Camptothecin