EARLY OVARIAN-CANCER - IS THERE A ROLE FOR SYSTEMATIC PELVIC AND PARAAORTIC LYMPHADENECTOMY

In order to focus on the incidence and the clinical significance of ly mphatic spread in patients with cancer apparently confined to the ovar ies, we present our 20 year experience in a large series of patients w ith early ovarian cancer who had systematic pelvic and para-aortic lym phadenectomy. A retrospective study of 280 consecutive patients is pre sented. Systematic pelvic and para-aortic lymphadenectomy was performe d in 205 cases (73.2%). Selective sampling and node biopsy were perfor med in 30 (10.7%) and 7 (2.5%), respectively. Node metastases were fou nd in 32/242 patients (13.2%). The incidence of metastatic nodes was s ignificantly higher in patients with serous adenocarcinomas and/or poo rly-differentiated tumors. When few nodes were involved (1-3) lymphati c spread was most ipsilateral to the tumor. Even though the retrospect ive nature of the study has to be considered, univariate analysis reve aled statistically significant differences in 5-year survival based on FIGO stage, histology, grade of differentiation, and node status. By contrast, using multivariate analysis, none of these risk factors was an independent variable for predicting long-term survival. However, no de status closely approached the statistically significant level (P = 0.06). Only prospective and randomized studies can clarify the role of lymphadenectomy in early ovarian cancer. However, while awaiting thes e results, this surgical procedure should be a part of a research prot ocol.