[Node clearance in ovarian cancer].
Iliac and lumboaortic lymphadenectomy is a frequent component of surgical treatment for ovarian carcinomas. These procedures carry specific risks and have poorly known immunological consequences. Two prospective randomized studies, one informs limited to the pelvis and the other in advanced disease, suggest that lymphadenectomy improves disease-free survival but not overall survival, although these findings are controversial. Modern imaging techniques (CT MRI, PET scan) and per-operative palpation are less sensitive than exhaustive histological examination of excised nodes. If lymphadenectomy is performed, it must be complete, including the external and primary iliac and lumboaortic chains up to the left renal vein, independently of the tumor location, as the lymphatic drainage pathway is difficult to predict in this setting In addition to their diagnostic value, node clearance also has therapeutic value. The risk of lymphatic invasion depends on the disease stage, grade, and histological type. Lymphadenectomy is not necessary for early-stage disease and is only warranted in advanced stages if the surgery is complete or the tumor residue is smaller than one centimeter.
Villet
Richard
R
Service de chirurgie viscérale et gynécologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, 18, rue du Sergent Bauchat, 75012 Paris. rvillet@hopital-dcss.org
Salet-Lizee
Delphine
D
D002277:Carcinoma / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D003952:Diagnostic Imaging; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods; D008207:Lymphatic Metastasis / Q000175:diagnosis; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010388:Pelvis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012680:Sensitivity and Specificity; D016019:Survival Analysis