Mesenteric Lymph Node Involvement as a Prognostic Factor in Ovarian Cancer: A Study Using a Standardized Detection Method

Yoshifumi Shimada; Koji Nishino; Junki Hasegawa; Masato Nakano; Mae Nakano; Akio Matsumoto; Daisuke Yamai; Hikaru Ozeki; Takahiro Minamikawa; Risa Kudo; Miho Suzuki; Nozomi Yachida; Akiko Kobayashi; Sosuke Adachi; Kosuke Yoshihara; Toshifumi Wakai

doi:10.1245/s10434-025-17779-8

Mesenteric Lymph Node Involvement as a Prognostic Factor in Ovarian Cancer: A Study Using a Standardized Detection Method

Ann Surg Oncol. 2025 Jul 12. doi: 10.1245/s10434-025-17779-8. Online ahead of print.

Authors

Affiliations

¹ Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan. shimaday@med.niigata-u.ac.jp.
² Department of Obstetrics and Gynecology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.
³ Division of Digestive and General Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan.

PMID: 40652147
DOI: 10.1245/s10434-025-17779-8

Abstract

Background: Mesenteric lymph node (MLN) involvement is frequently observed in patients undergoing cytoreductive surgery for ovarian cancer (OC) with rectosigmoid invasion. However, MLN detection methods are not standardized, and the clinical significance of MLN involvement remains controversial. This study aimed to investigate the clinical significance of MLN involvement in patients with OC using a standardized detection method.

Methods: The study included 171 patients with stage II, III, or IV OC who underwent cytoreductive surgery. The analysis detected MLN in patients who underwent rectosigmoid resection in the same manner as for colorectal cancer: systematic regional lymph node dissection followed by systematic extraction and histopathologic examination of MLN.

Results: Of the 171 patients, 57 underwent rectosigmoid resection. In 56 patients (98.2 %), MLNs were detected, with a median of nine (range, 0-51) dissected nodes. Histopathologic examination confirmed MLN involvement in 30 of these 57 patients. The independent prognostic factors for progression-free survival identified by multivariate analysis were residual tumor status (P = 0.002), ascitic cytology (P = 0.034), and MLN involvement (P = 0.010). Among the 86 patients who underwent complete cytoreductive surgery, MLN involvement was significantly associated with worse prognosis (P < 0.001). However, for the 85 patients who underwent optimal or suboptimal cytoreductive surgery, MLN involvement was not a significant prognostic factor.

Conclusions: In patients with OC, MLN involvement is an important prognostic factor, particularly for those undergoing complete cytoreductive surgery. Evaluation of MLNs using a standardized detection method in the same manner as for colorectal cancer may help identify patients at higher risk for a poor prognosis.

Keywords: Clinical significance; Complete cytoreductive surgery; Mesenteric lymph node involvement; Ovarian cancer; Prognostic factor; Rectosigmoid resection; Standardized detection method.

Grants and funding

JP19K09116/Japan Society for the Promotion of Science