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Should be para-aortic lymphadenectomy up to the level of the renal vein mandatory in ovarian cancer patients presenting ovarian cancer presumed to be confined to the ovary?

Authors
Chang, Suk-Joon; Bristow, Robert E.; Paek, Jiheum; Kong, Tae Wook; Ryu, Hee-Sug; DiSaia, Philip J.
Department
Department of Obstetrics & Gynecology
Abstract
Objective: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients with presumed to be confined to the ovary during the primary staging surgery.

Methods: We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were thought to have tumor confined to the ovary without any gross metastatic lesions and underwent primary staging surgery.

Results: Eighty-seven patients (70.2%) had FIGO stage I disease – 54 IA, 2 IB, and 31 IC – and 37 (29.8%) had stage II-III disease – 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Pelvic and para-aortic lymphadenectomy were performed in 86 and 69 patients, respectively. Lymph node (LN) metastases were found in 17 of 86 patients (19.8%). Of 17 patients with LN metastasis, 5 patients (29.4%) had LN metastasis in pelvic LN only, 8 (47.1%) in para-aortic LN only, and 4 (23.5%) in both pelvic and para-aortic LNs. Six patients (35.3%) had LN metastasis in para-aortic LN above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p = 0.01) and positive cytology (p = 0.03) were independent predictors for LN metastasis.

Conclusions: A substantial number of patients with apparently early ovarian cancer had upstaged disease. Some patients had positive para-aortic lymph nodes above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels could detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.
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