SYSTEMATIC PELVIC AND PARAAORTIC LYMPHADENECTOMY IN ADVANCED OVARIAN-CANCER PATIENTS WITH NO RESIDUAL INTRAPERITONEAL DISEASE

A comparative non-randomized study was carried out to evaluate the rol e of systematic pelvic and para-aortic lymphadenectomy (SL) on patient s with no residual intraperitoneal disease (NRID) of advanced ovarian cancer (stage IIIC-IV). A total of 142 optimally cytoreduced patients (macroscopic disease absent on peritoneal surface) were divided into t wo groups: Group A, consisting of 98 patients (53 previously untreated and 45 pretreated at other Institutions), who underwent SL; Group B, consisting of 44 patients (21 previously untreated and 23 pretreated a t other Institutions), who did not undergo SL. Each group had statisti cally equivalent histology, grading, performance status and variety of cytoreductive operations performed. Group A pretreated patients had a greater number of stage III than Group B (P=0.03). Systematic pelvic and para-aortic lymphadenectomy could be carried out with an acceptabl e morbidity and no mortality. All 142 patients received post-operative chemotherapy including carboplatin. The number of chemotherapy sessio ns did not differ between the two groups. Comparison of survival revea led that SL significantly improved the survival of previously untreate d patients (P=0.02). The survival was significantly different with nod al status (P=0.006). Cox's proportional hazard analysis showed that on ly systematic lymphadenectomy was a significant covariate. The surviva l was not significantly different in Group A vs Group B pretreated pat ients; however, it was significantly different with respect to nodal s tatus (P<0.001). Cox's proportional hazard analysis showed that only t he initial stage of disease was a significant covariate. The results o f the present study shows that aggressive surgical cytoreduction with SL could be therapeutic in previously untreated patients with NRID. Cu rrently, an international prospective randomized study is ongoing to c larify definitively the clinical role of SL.