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Systematic Para-aortic and Pelvic Lymphadenectomy in Early Stage Epithelial Ovarian Cancer: A Prospective Study

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Lymphadenectomy is important in the surgical treatment of apparent early epithelial ovarian cancers (eEOC); however, its extent is not well defined. We evaluated the role of systematic lymphadenectomy, the risk factors related with lymph node metastases, the implications, and the morbidity of comprehensive surgical staging.

Methods

We prospectively recruited 124 patients diagnosed with apparent eEOC [International Federation of Gynecology and Obstetrics (FIGO) stage I and II] between January 2003 and January 2011. Demographics, surgical procedures, morbidities, pathologic findings, and correlations with lymph node metastases were assessed.

Results

A total of 111 patients underwent complete surgical staging, including lymphadenectomy, and were therefore analyzed. A median of 23 pelvic and 20 para-aortic nodes were removed. Node metastases were found in 15 patients (13.5 %). The para-aortic region was involved in 13 (86.6 %) of 15 cases. At univariate analysis, age, menopause, FIGO stage, grading, and laterality were found to be significant factors for lymph node metastases, while CA125 of >35 U/ml and positive cytology were not. No lymph node metastases were found in mucinous histotypes. At multivariate analysis, only bilaterality (p = 0.018) and menopause (p = 0.032) maintained a statistically significant association with lymph node metastases. Lymphadenectomy-related complications (lymphocyst formation and lymphorrhea) were found in 14.4 % patients.

Conclusions

The data of this prospective study demonstrate the prognostic value of lymphadenectomy in eEOC. Menopause, age, bilaterality, histology, and tumor grade are identifiable factors that can help the surgeon decide whether to perform comprehensive surgical staging with lymph node dissection. These parameters may be used in planning subsequent treatment.

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Conflict of interest

The authors have no conflicts of interest.

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Authors and Affiliations

  1. Department of Gynecologic Oncology, IRCCS National Cancer Institute, Milan, Italy

    Antonino Ditto MD, Fabio Martinelli MD, Eugenio Solima MD, Rosanna Fontanelli MD & Francesco Raspagliesi MD

  2. Department of Gynecology and Obstetrics, Treviglio Hospital, Bergamo, Italy

    Claudio Reato MD

  3. Department of Surgery, IRCCS National Cancer Institute, Milan, Italy

    Shigeky Kusamura MD

  4. Department of Anesthesiology, IRCCS National Cancer Institute, Milan, Italy

    Edward Haeusler MD

Authors
  1. Antonino Ditto MD
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  2. Fabio Martinelli MD
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  3. Claudio Reato MD
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  4. Shigeky Kusamura MD
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  5. Eugenio Solima MD
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  6. Rosanna Fontanelli MD
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  7. Edward Haeusler MD
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  8. Francesco Raspagliesi MD
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Correspondence to Antonino Ditto MD.

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Ditto, A., Martinelli, F., Reato, C. et al. Systematic Para-aortic and Pelvic Lymphadenectomy in Early Stage Epithelial Ovarian Cancer: A Prospective Study. Ann Surg Oncol 19, 3849–3855 (2012). https://doi.org/10.1245/s10434-012-2439-7

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  • DOI: https://doi.org/10.1245/s10434-012-2439-7

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