J Gynecol Oncol.  2013 Jan;24(1):29-36. 10.3802/jgo.2013.24.1.29.

Analysis of para-aortic lymphadenectomy up to the level of the renal vessels in apparent early-stage ovarian cancer

• Chang SJ
• Bristow RE
• Ryu HS

• KMID: 2288558
• DOI: http://doi.org/10.3802/jgo.2013.24.1.29

Abstract

OBJECTIVE
The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary.
METHODS
We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node metastasis and various risk factors for nodal involvement were investigated.
RESULTS
Surgical staging yielded: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para-aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis.
CONCLUSION
A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para-aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis.

Keyword

Early-stage ovarian cancer; Lymph node metastasis; Para-aortic lymphadenectomy

MeSH Terms

Female
Gynecology
Humans
Lymph Node Excision
Lymph Nodes
Mesenteric Artery, Inferior
Multivariate Analysis
Neoplasm Metastasis
Neoplasms, Glandular and Epithelial
Obstetrics
Ovarian Neoplasms
Ovary
Prognosis
Retrospective Studies
Risk Factors
Neoplasms, Glandular and Epithelial
Ovarian Neoplasms

Figure

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  Fig. 1 Surgical procedures performed. TAH, total abdominal hysterectomy; BSO, bilateral salpingo-oophorectomy; USO, unilateral salpingo-oophorectomy.

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  Fig. 2 (A) Progression-free survival and (B) overall survival by lymphadenectomy.

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