title: Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications.
abstract: BACKGROUND
  The purpose was to determine the factors influencing nodal involvement and topography of pelvic and paraaortic node involvement in ovarian carcinoma.
  
  
  METHODS
  Between 1985 and 2001, 276 women with epithelial ovarian carcinoma underwent systematic bilateral pelvic and paraaortic lymphadenectomy.
  
  
  RESULTS
  The overall frequency of lymph node involvement was 44% (122 of 276). The frequency of pelvic and paraaortic metastases were 30% (82 of 276) and 40% (122 of 276), respectively. The frequency of lymph node metastases according to the stage of the disease (stages I, II, and III + IV) were: 20% (17 of 85), 40% (6 of 15), and 55% (99 of 176), respectively. In patients with stage IA, IB, and IC disease, the rates of nodal involvement were 13% (8 of 60), 33% (4 of 12), and 38% (5 of 13), respectively. None of 15 patients with stage IA grade 1 disease had nodal involvement. None of the 20 patients with mucinous tumors confined to the ovary(ies) (stage I disease) had nodal involvement. When paraaortic nodes were involved, the left paraaortic chain above the level of the inferior mesenteric artery was the most frequently involved site (70 patients, 63%). One of nine patients (11%) with a macroscopic stage I unilateral tumor and paraaortic involvement had contralateral metastases.
  
  
  CONCLUSIONS
  Lymphadenectomy should be performed even in patients with stage IA disease. This procedure could be omitted in patients with mucinous apparent stage I disease and stage I grade 1 tumor. Lymphadenectomy should involve the whole pelvic and paraaortic chain up to the level of the left renal vein. A bilateral dissection should be performed even in cases of patients with a unilateral tumor.
authors.affiliation: Department of Surgery, Institut Gustave Roussy, Villejuif, France.
authors.forename: Philippe
authors.initials: P
authors.lastname: Morice
authors.forename: Franklin
authors.initials: F
authors.lastname: Joulie
authors.forename: Sophie
authors.initials: S
authors.lastname: Camatte
authors.forename: David
authors.initials: D
authors.lastname: Atallah
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.forename: Patricia
authors.initials: P
authors.lastname: Pautier
authors.forename: Christophe
authors.initials: C
authors.lastname: Pomel
authors.forename: Catherine
authors.initials: C
authors.lastname: Lhommé
authors.forename: Pierre
authors.initials: P
authors.lastname: Duvillard
authors.forename: Damienne
authors.initials: D
authors.lastname: Castaigne
mesh_terms: D000230:Adenocarcinoma / Q000556:secondary* / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision / Q000379:methods*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology* / Q000601:surgery*; D010388:Pelvis