CYTOREDUCTIVE SURGERY IN ADVANCED EPITHELIAL CANCER OF THE OVARY - THE IMPACT OF AORTIC AND PELVIC LYMPHADENECTOMY

Beginning in July 1988, a planned program was undertaken to assess the role of aortic and pelvic lymphadenectomy in patients with advanced e pithelial cancer of the ovary (Stages IIIa-IVa) undergoing cytoreducti ve surgery. Our intent was to perform a complete aortic and pelvic lym phadenectomy in all patients in whom we could surgically remove all in tra- or retroperitoneal disease measuring 1 cm or greater. Accordingly , 56/77 patients (73%) underwent complete aortic and pelvic lymphadene ctomy. The remaining 21/77 patients (27%) did not, either because the lymphadenectomy would not have impacted on the patient's cytoreductive status or because intraoperative conditions precluded it. Positive lu mph nodes were found in 36/56 patients (64%). Of these, 23/36 (64%) we re macroscopically positive, and if left in situ would have affected t he patient's cytoreductive status. Thirteen of 36 (36%) were positive microscopically. Reassessment laparotomy was performed in 44/56 (79%) of the patients having had a lymphadenectomy and is correlated to dise ase status. Median follow-up is 30 months (range 2-64 months). Surviva l analysis reveals: 10/20 patients (50%) with negative lymph nodes; 6/ 13 patients (46%) with microscopically positive lymph nodes; 10/23 pat ients (43%) with macroscopically positive, but surgically removed lymp h nodes; and only 2/21 patients (10%) with residual disease measuring at least 1 cm in diameter are alive without evidence of disease. These preliminary findings suggest that the removal of macroscopically nega tive lymph nodes offers little benefit to the patient with advanced ep ithelial cancer and minimal residual (less than 1 cm) disease. However , the concept of cytoreductive surgery, whether it be intra- or retrop eritoneal, appears to be validated by the fact that the patients under going removal of macroscopically positive lymph nodes have approximate ly the same chance of survival as those with microscopically positive and/or negative lymph nodes. (C) 1995 Academic Press, Inc.