Value of lymph node assessment in ovarian cancer: Status of the art at theend of the second millennium

Available data on the incidence and the clinical value of lymph node assess ment in ovarian cancer are reported. In early ovarian cancer, positive node s are found in 4-25% of patients. Serous adenocarcinoma and poorly differen tiated tumors are characterized by the highest incidence of node metastases . Five-year survival for stage IIIC disease with only retroperitoneal sprea d is clearly better than for stage IIIC with intraperitoneal dissemination. In advanced ovarian cancer, the rate of node involvement ranges from 55 to 75%. The percentage of positive nodes is significantly related to the amou nt of residual tumor after cytoreductive surgery, and node status seems to be an important prognostic factor for survival. Although data from retrospe ctive studies advocate a therapeutic effect for systematic lymphadenectomy, results from prospective randomized trials are warranted. After chemothera py a high percentage of patients (range, 25-77%) are found to have metastat ic nodes. In particular, at second-look laparotomy, positive nodes are dete cted in 17-40% of patients who have no intraperitoneal disease.