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Lymphadenectomy in ovarian cancer: standard of care or unnecessary risk

Trimbos, J. Baptist

doi: 10.1097/CCO.0b013e32834847e7
Gynecologic cancer: Edited by Martin Gore
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Purpose of review The clinical significance of lymphadenectomy in ovarian cancer is controversial. In early ovarian cancer (EOC), it is the extent of the procedure that is the main focus of debate. In advanced disease [advanced ovarian cancer (AOC)], the issue is whether or not lymphadenectomy independently impacts survival. This review summarizes the current standard of care as it relates to the role of lymphadenectomy in ovarian cancer.

Recent findings Lymphadenectomy in EOC is a diagnostic procedure in as much as it is an integral and mandatory part of a complete surgical staging. The required extent of the procedure, however, remains uncertain. It has been suggested that at least 10 nodes from different, predefined retroperitoneal sites should be the minimum number removed. Lymphadenectomy in AOC is of potential therapeutic value. The only published randomized clinical trial (RCT) showed no overall survival benefit after radical/systematic lymphadenectomy, although there was an impact on 6-month disease-free survival. Conversely, retrospective studies, a meta-analysis and a re-analysis of three RCTs in AOC do suggest an overall survival benefit for radical/systematic lymphadenectomy.

Summary This review concludes with the recommendation that lymphadenectomy in EOC is a mandatory part of surgical staging and that a minimum of 10 nodes should be harvested from different retroperitoneal sites. In AOC, lymphadenectomy can be considered when intraperitoneal cytoreduction has been complete or when there are bulky nodes.

Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands

Correspondence to J.B. Trimbos, Professor and Chairman, Department of Gynecology, Leiden University Medical Center, Leiden, The Netherlands Tel: +31 71 5262845; fax: +31 71 5248181; e-mail: j.b.m.z.trimbos@lumc.nl

© 2011 Lippincott Williams & Wilkins, Inc.