108\u2005A subxiphoid approach to the resection of enlarged cardiophrenic lymph nodes in primary treatment of advanced ovarian cancer

Abstract

Objectives To demonstrate a subxiphoid approach to the resection of enlarged cardiophrenic lymph nodes (CPLNs) in primary cytoreductive surgery for advanced ovarian cancer (OC). Methods We assembled video footage from a primary debulking surgery performed for a patient with OC and cardiophrenic lymphadenopathy. The lymph nodes were resected in addition to the abdominopelvic tumor debulking, leaving the patient with no gross residual disease. Results Key components of the subxiphoid approach for cardiophrenic lymphadenectomy are shown. These include entering the thoracic cavity by incising under the xiphoid process, resecting enlarged lymph nodes, and closing the defect. The vertical midline abdominal incision is extended to expose the xiphoid process. The CPLNs are identified. The pleural cavity may be entered to improve exposure. The surgeon can palpate the enlarged lymph nodes and remove them though the subxiphoid opening. After adequate hemostasis is achieved and a chest tube placed, the defect is closed. Conclusions Using still photographs and video, we demonstrate the technique for accessing the mediastinum through a subxiphoid approach, obviating the necessity of entering through the diaphragm.