Lymphadenectomy in primary carcinoma of the Fallopian tube

Objective: The bad prognosis of primary carcinoma of the Fallopian tube is ascribed to early lymphogenous metastasis. Due to the rarity of cases, ther e exist only few and divergent results on the importance of lymph node meta stasis in the relevant literature. Thus, our study aimed at detecting the i ncidence of lymph node metastases and their influence on overall survival, as well as at evaluating the therapeutic effect of radical lymphadenectomy. Methods: We studied 158 cases of primary carcinoma of the Fallopian tube i n a retrospective multicenter analysis. Group I (n = 38) consisted of patie nts who were subjected to radical pelvic and para-aortic lymphadenectomy in addition to total abdominal hysterectomy, bilateral adenectomy and omentec tomy. The control group II (n = 71) underwent the same surgical procedures but without radical lymphadenectomy. Patients who received post-operative i rradiation (n = 49) were excluded from the study. Results: On average, 38 l ymph nodes (range 12-68) were extirpated. In group I 42.1% of the cases sho wed lymph node metastases. Lymphatic dissemination was observed only after the carcinoma had spread beyond the organ (intraabdominal stage II); the in cidence of lymph node metastases rose significantly (P = 0.02) with growing intraperitoneal tumour masses. Pelvic and para-aortic metastases occur sim ultaneously. Overall survival with tumour of equal size is markedly, but no t significantly reduced (P = 0.18) if the lymph nodes are involved. If, how ever, radical lymphadenectomy is performed (group I) the median survival ti me increases to 43 months (95% confidence-interval 20-66), compared with 21 months (95% confidence-interval 10-32) in group II (P = 0.095). Conclusion : Correct staging is obtained only on the basis of pelvic and para-aortic l ymphadenectomy. Radical lymphadenectomy in tumours of equal size may marked ly prolong survival. (C) 1999 Elsevier Science Ireland Ltd. AU rights reser ved.