Early ovarian cancer: Is there a role for systematic pelvic and para-aortic lymphadenectomy?

Abstract

Baiocchi G, Raspagliesi F, Grosso G, Fontanelli R, Cobellis L, di Re E, di Re F. Early ovarian cancer: Is there a role for systematic pelvis and para‐aortic lymphadenectomy? Int J Gynecol Cancer 1998; 8: 103–108. In order to focus on the incidence and the clinical significance of lymphatic spread in patients with cancer apparently confined to the ovaries, we present our 20 year experience in a large series of patients with early ovarian cancer who had systematic pelvic and para‐aortic lymphadenectomy. A retrospective study of 280 consecutive patients is presented. Systematic pelvic and para‐aortic lymphadenectomy was performed in 205 cases (73.2%). Selective sampling and node biopsy were performed in 30 (10.7%) and 7 (2.5%), respectively. Node metastases were found in 32/242 patients (13.2%). The incidence of metastatic nodes was significantly higher in patients with serous adenocarcinomas and/or poorly‐differentiated tumors. When few nodes were involved (1–3) lymphatic spread was most ipsilateral to the tumor. Even though the retrospective nature of the study has to be considered, univariate analysis revealed statistically significant differences in 5‐year survival based on FIGO stage, histology, grade of differentiation, and node status. By contrast, using multivariate analysis, none of these risk factors was an independent variable for predicting long‐term survival. However, node status closely approached the statistically significant level (P = 0.06). Only prospective and randomized studies can clarify the role of lymphadenectomy in early ovarian cancer. However, while awaiting these results, this surgical procedure should be a part of a research protocol.

Results of conservative treatment in epithelial ovarian carcinoma

“…26 Baiocchi et al reported a rate of lymph node involvement of 12.9% and 14.7% in patients with Stage IA and IB disease, respectively. 18 These rates according to the grade were 3.9% in Grade 1, 7.7% in Grade 2, and 38.5% in Grade 3 Stage I tumors, respectively. 18 In the series reported by Meier, 5% and 39% of patients with Grade 2 and 3 tumors had lymph node involvement.…”

“…18 These rates according to the grade were 3.9% in Grade 1, 7.7% in Grade 2, and 38.5% in Grade 3 Stage I tumors, respectively. 18 In the series reported by Meier, 5% and 39% of patients with Grade 2 and 3 tumors had lymph node involvement. 26 Such patients were upstaged to Stage IIIC disease.…”

“…28 Baiocchi reported 3 cases of contralateral lymph node involvement of 24 patients with Stage IA disease. 18 Recently, Walter and Magrina reported a case of lymph node recurrence contralateral to the initial tumor. 29 According to these data, it seems that a complete bilateral lymphadenectomy (with preservation of the vascular pedicle of the remaining ovary) should be performed even in patients with Stage I EOC.…”

Stage IIIC epithelial ovarian cancer classified solely by lymph node metastasis has a more favorable prognosis than other types of stage IIIC epithelial ovarian cancer

“…Up to 10-25% of patients with presumable early stage disease which is confined to the ovaries or pelvis are upstaged after thorough surgical staging procedure due to pelvic lymph node metastasis. [18][19][20][21] Paraaortic lymph nodes were positive in 6% of these patients. 19 Because lymph node involvement is an important prognostic factor, 7-9,22 patients with metastasized lymph nodes is assigned stage IIIC even if their intraperitoneal disease is equivalent to stage I-IIIB according to the FIGO staging system for ovarian cancer.…”

Management of retroperitoneal lymph nodes in the treatment of ovarian cancer

“…More than one-third of poorly differentiated (grade 3) tumors had node metastases. 14,16 The distribution of positive nodes has been described by minute investigation. In macroscopic unilateral ovarian cancer, involvement of the ipsilateral pelvic node alone was found as the most frequent (56.4%).…”