RESPONSE: Re: Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial

Nodal status—its impact on prognosis in advanced ovarian cancer

“…The risk of node positivity is about 40% in advanced ovarian cancer (Du Takeshima et al 2005). About 55% of patients with ovarian cancer have node metastases in pelvic or para-aortic nodes (Panici et al 2005;Takeshima et al 2005). Carnino described a signiWcant correlation (P < 0.0001) of node-positive cases in poor diVerentiated tumors (G3) (Carnino et al 1997) according to our data (Table 2).…”

“…Studies (like SCOTROC-1 study) have investigated the eVect of systematical pelvic and para-aortic lymphadenectomy (Crawford et al 2005). The randomized trial of Panici et al 2005 described that systematic lymphadenectomy improves PFS, but not OS in patients with optimally debulked advanced ovarian cancer compared with the resection of bulky nodes. A signiWcant beneWt for PFS for patients with no residual tumor was seen with pelvic and para-aortic lymphadenectomy (Crawford et al 2005).…”

“…In advanced FIGO stages, patients with residual tumor mass <1 cm (1-10 mm) show signiWcant beneWt on PFS with systematical pelvic and para-aortic lymphadenectomy, but no signiWcant beneWt on OS (Crawford et al 2005). Therefore, in all patients with primary ovarian cancer and with R0 resection or minimal residual tumor (R > 0 mm-1 cm), a systematical pelvic and para-aortic lymphadenectomy is part of surgery and seems to have positive impact on prognosis (Du Harter et al 2009;Kim et al 2010;Onda et al 1998;Panici et al 2005;Scarabelli et al 1997), as described in our data. But these data must be checked with prospective studies.…”

“…The randomized trial of Panici et al in (2005) showed a positive impact of a systemic lymphadenectomy on progression-free survival (PFS) compared to resection of bulky nodes, but no impact of lymphadenectomy on overall survival (OS) in optimally debulked patients (Panici et al 2005). Optimal tumor debulking is deWned as residual tumor mass less than 1 cm.…”

Robotic retroperitoneal lymph node dissection in gynaecological neoplasms: comparison of extraperitoneal and transperitoneal lymphadenectomy

“…Retroperitoneal lymph node involvement occurs in 5-25 and 50-80 % of women with early and advanced ovarian cancer, respectively. Retrospective studies showed that lymph node dissection is associated with an improvement of staging, complete cytoreduction and a survival benefit, even though current ongoing prospective trial on ovarian cancer (LION study) will help give a definitive answer on this issue and investigate if these data-especially the node ratio-have therapeutic implications and may be considered in future staging [9][10][11][12]37].…”