Pelvic and Para-Aortic Lymph Nodal Positivity in the Ovarian Carcinoma

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

“…In early stage ovarian cancer, positive nodes can be found in nine to 25% of patients (Baiocchi et al, 1998). Such variabilility is due to the relatively small size of patient series and the heterogeneity of techiques used to detect and remove retroperitoneal nodes which span from simple sampling (Chen and Lee, 1983;Lanza et al, 1988;Carnino et al, 1997) to systematic lymphadenectomy (Di Re et al, 1989;Burghadt et al, 1991;Benedetti Panici et al, 1993;Carnino et al, 1997;Baiocchi et al, 1998). Our findings are in keeping with these data but represent the first direct comparison of the two surgical approaches to retroperitoneal nodes and are not hampered by the methodologic constrains of retrospective analyses.…”

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

“…Some previous studies suggested that the prognoses of stage IIIC patients who are upstaged based on lymph node positivity are as poor as those of patients with stage IIIC based on intraperitoneal tumor spread. 7,23,24 [25][26][27] However, the better survival of patients upstaged to stage IIIC by positive lymph nodes compared to patients with other stage IIIC could simply reflect the prognostic impact of small versus large tumor size. 28 Therefore, a comparison between stage IIIC solely by lymph node metastasis and stage IIIA/IIIB patients would be more appropriate and provide evidence about possible differences in the biological and clinical behavior of lymph node versus peritoneal metastasis.…”

Patients with ovarian carcinoma upstaged to Stage III after systematic lymphadenctomy have similar survival to Stage I/II patients and superior survival to other Stage III patients

“…Knapp and Friedman 1 reported that all of 3 patients died of their disease within 30 months of surgery, which included aortic lymph node biopsy. Furthermore, Lanza et al 16 observed that only 1 of 10 patients who underwent selective sampling of aortic and pelvic lymph nodes was alive without recurrence 3 years after surgery. When these reports are considered together, it seems that patients with tumors limited to the ovaries and positive lymph nodes have poor prognoses as long as only lymph node sampling is performed.…”

“…15 When only lymph node biopsies are performed, the prognoses of Stage III patients upstaged based on lymph node positivity are known to be as poor as those of patients with Stage III based on intraperitoneal tumor spread. 1,16,17 Since 1987, in principle, we have performed systematic aortic and pelvic lymphadenectomy along with optimal cytoreduction at initial surgery on Stage I-III ovarian carcinoma patients. We wondered whether systematic lymphadenectomy had therapeutic value, beyond its significance to accurate staging, for patients upstaged to Stage III because of lymph node positivity.…”