High-level resection of the infundibulopelvic ligament during surgery of epithelial ovarian cancer is necessary: a retrospective comparative study.

BACKGROUND

Ovarian cancer is a highly lethal gynecological malignancy, with epithelial ovarian cancer (EOC) being its most common form. Surgery combined with chemotherapy is the standard treatment. Resection completeness significantly impacts patient prognosis and survival. Lymphatic, hematogenous, and transcoelomic routes are potential pathways for EOC metastasis, and the infundibulopelvic (IP) ligament is considered a possible route for cancer cells to reach para-aortic and pelvic lymph nodes. This study aimed to evaluate the necessity and clinical significance of high-level resection (HLR) (≥10 cm) of the IP ligament during EOC surgery.

METHODS

This retrospective comparative study included 80 EOC patients [Federation International of Gynecology and Obstetrics (FIGO) stages I-IV] who underwent bilateral HLR (ligation ≥10 cm from the ovarian margin) of the IP ligament during cytoreductive surgery at West China Second University Hospital from October 2019 to June 2023. A control group of 93 EOC patients (same FIGO stages) without HLR (WHLR) during the same period was randomly selected. IP ligament metastasis was confirmed histopathologically. Post-operative data were collected mainly through a combination of outpatient clinic visits and computed tomography (CT) imaging to assess para-aortic lymph node metastasis. Statistical analysis used SPSS 26.0, with quantitative data analyzed by t-tests and qualitative data by χ2 test or Fisher's exact test. P<0.05 indicated statistical significance.

RESULTS

In the HLR group, IP ligament metastasis was detected in 19/80 patients (23.8%). The in vivo length of resected IP ligaments averaged 11.6 cm (range, 10-15 cm) and 7.48 cm (range, 6-10 cm) in fixed specimens. Baseline characteristics and intraoperative complication rates (e.g., ureteral or vascular injuries) were comparable between groups. IP ligament metastasis was significantly correlated with para-aortic lymph node metastasis (P=0.005). Postoperative follow-up CT scans revealed the incidence of postoperative para-aortic lymph node metastasis was higher in the WHLR group compared to the HLR group, with this difference becoming more pronounced over extended follow-up. The median follow-up time was 30 months (range, 24-36 months).

CONCLUSIONS

In EOC patients, our study suggests that HLR (≥10 cm) of the IP ligament may reduce the risk of postoperative para-aortic lymph node metastasis by eliminating potential cancer sites and metastatic pathways. These findings imply that high-level IP ligament resection could be a valuable component of cytoreductive surgery. However, due to the study's small sample size and short follow-up, larger prospective trials are needed to confirm these results and determine the optimal resection length for improved patient outcomes.