Significance of Lymph Node Sampling in Epithelial Carcinoma of the Ovary

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.…”

“…The prevalence of lymph node involvement depends closely on the stage of the disease and the number of lymph nodes removed and examined (Burghadt et al, 1991;Carnino et al, 1997). Our study shows that when lymphadenectomy is systematically performed, nearly a fourth of patients with 'early-stage' ovarian cancer turns out to have retroperitoneal lymphatic spread.…”

“…Lymph node involvement varies according to stage and depends closely on the number of lymph nodes removed and examined. In series of stage I patients undergoing lymph nodes sampling the prevalence ranged from 2% (Tsuruchi et al, 1993) to 4,2% (Carnino et al, 1997) while ranged from 13% (Di Re et al, 1989) to 24% (Burghadt et al, 1991) in series of reported stage I patients undergoing pelvic alone or pelvic and aortic lymphadenectomy. Therefore, the trial was planned to recruit 280 patients to demonstrate a 10% difference in the prevalence of lymph node positivity from 5% in nonlymphadenectomy arm to 15% in lymphadenectomy arm with at least 80% power (using a two-sided test and alpha of 5%).…”

“…In fact, the presence of node metastases upstages the patients to FIGO stage IIIc disease and these patients are appropriate candidates for adjuvant postoperative chemotherapic treatments. As prevalence of lymph node metastases depends closely on the number of lymph nodes removed and examined (Carnino et al, 1997) we have designed a randomised trial to evaluate the role of systematic lymphadenectomy at primary surgery in patients with ovarian cancer macroscopically confined to the pelvis. Objectives of this study were to provide insight into the biologic significance of node metastases on clinical behavior and to assess the impact of systematic lymphadenectomy on progression-free and overall survival.…”

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

“…However, the role of retroperitoneal nodal resection remains unclear, particularly for advanced-stage disease. In a retrospective review of 127 patients, Carnino et al (1997) reported that the probability of finding a lymph node metastasis was significantly higher when more lymph nodes were removed. These authors suggested that systematic lymphadenectomy should be performed, rather than lymph node sampling, to determine the therapeutic impact of lymph node resection in epithelial ovarian cancers.…”