{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T06:18:50Z","timestamp":1783491530442,"version":"3.55.0"},"reference-count":45,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T00:00:00Z","timestamp":1783468800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>The LION and CARACO trials demonstrated that routine systematic pelvic and para-aortic lymphadenectomy (LAD) confers no survival benefit in clinically node-negative advanced epithelial ovarian cancer (EOC), while significantly increasing perioperative morbidity. However, these trials evaluated unselected populations without molecular stratification. This review proposes an omics-guided, anatomically precise surgical paradigm to identify patients who may benefit from selective retroperitoneal clearance.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A synthesis of recent landmark clinical trials, international surgical guidelines, and emerging multi-omics datasets was conducted to evaluate retroperitoneal lymph nodes as complex architectural niches characterized by passive drug diffusion limits and chemotherapy-induced structural remodelling.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Approximately 30\u201350% of advanced high-grade serous EOC cases exhibit primary or acquired resistance to standard platinum\/taxane chemotherapy. Biological and spatial transcriptomic data indicate that retroperitoneal nodes can act as sanctuaries where resistant clones persist despite systemic therapy, driving later recurrence. Validated preoperative biomarkers; including homologous recombination proficiency (HRD-negative status), investigational markers such as enhancer-associated MSH6 downregulation and specific proteomic panels under investigation (e.g., PRKAR2B\/SKP2) show strong predictive potential for primary chemoresistance within exploratory validation cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>A one-size-fits-all approach to surgical de-escalation tends to overlook a critical, molecularly defined minority. Shifting the surgical paradigm toward biomarker-guided anatomical precision offers a conceptual, hypothesis-generating blueprint for future clinical trials, testing whether restricting systematic para-aortic lymphadenectomy to preoperatively identified chemoresistant subsets provides true therapeutic utility.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fmed.2026.1883825","type":"journal-article","created":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T05:57:39Z","timestamp":1783490259000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Anatomical precision in the omics era: a proposed framework for selective para-aortic lymphadenectomy in epithelial ovarian cancer"],"prefix":"10.3389","volume":"13","author":[{"given":"Roli","family":"Purwar","sequence":"first","affiliation":[{"name":"Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dency","family":"Hansalia","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meenu","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anvitha","family":"Manoj","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manoj","family":"Pandey","sequence":"additional","affiliation":[{"name":"Department of Surgical Oncology, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]},{"name":"HTAIn Resource Centre, Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]},{"name":"DHR-ICMR Advanced Molecular Oncology Diagnostic Services (DIAMOnDS), Institute of Medical Sciences, Banaras Hindu University","place":["Varanasi, India"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,8]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"7018","DOI":"10.1002\/cam4.2560","article-title":"Ovarian cancer: current status and strategies for improving therapeutic outcomes","volume":"8","author":"Chandra","year":"2019","journal-title":"Cancer Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"103","DOI":"10.1016\/0090-8258(91)90099-q","article-title":"Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer","volume":"40","author":"Burghardt","year":"1991","journal-title":"Gynecol 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