title: The impact of pelvic retroperitoneal invasion and distant nodal metastases in epithelial ovarian cancer.
abstract: BACKGROUND
  The absence of disease after debulking surgery is the most important prognostic factor in the treatment of advanced epithelial ovarian cancer (EOC). Occasionally, the presence of extra-abdominal disease complicates the ability to obtain a complete surgery, considering some locations of the metastatic disease as unresectable. The objective of the study was to estimate the survival impact of pelvic retroperitoneal invasion and extrapelvic and aortic distant nodal metastases in EOC patients. The anatomical landmarks of primary cytoreductive surgery will be discussed.
  
  
  METHODS
  We reviewed data from 116 consecutive Mayo Clinic patients with epithelial ovarian cancer (EOC) stage IIIC and IV, undergoing primary cytoreduction surgery between 1996 and 2000. Univariate and multivariate analysis for patients with positive distant nodes and pelvic retroperitoneal invasion was performed, including 57 patients with no residual disease after surgery. Kaplan-Meier curves were used to estimate the probability of survival.
  
  
  RESULTS
  The median patient's age was 65 years (range 24-87 years). The 5 years overall survival was 44.8% (range 30.1-57.9 months) and the median length of survival was 39.9 months (range 0.13-60 months, 95% confidence interval: 30.1-57.9). Pelvic retroperitoneal invasion was present in 22 EOC patients (18.9%) and distant positive nodes were noted in 11 (9.5%): suprarenal/celiac (5.2%), inguinal (4.3%) and supraclavicular (0.9%). Univariate and multivariate Cox regression analysis, identified distant positive lymph nodes and pelvic retroperitoneal invasion as factors statistically associated with overall survival (p = 0.002 and p = 0.025, respectively).
  
  
  CONCLUSIONS
  Metastatic distant nodes and pelvic retroperitoneal invasion are independent prognostic factors for survival in patients with advanced EOC.
authors.affiliation: Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain. Electronic address: apereiras@sego.es.
authors.forename: Augusto
authors.initials: A
authors.lastname: Pereira
authors.affiliation: Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Madrid, Spain.
authors.forename: Tirso
authors.initials: T
authors.lastname: Pérez-Medina
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, AZ, USA.
authors.forename: Javier F
authors.initials: JF
authors.lastname: Magrina
authors.affiliation: Division of Gynecologic Surgery, Mayo Clinic, AZ, USA.
authors.forename: Paul M
authors.initials: PM
authors.lastname: Magtibay
authors.affiliation: Department of Gynecology and Obstetrics, College of Medicine, Autonoma University, Madrid, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Rodríguez-Tapia
authors.affiliation: Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain.
authors.forename: Federico
authors.initials: F
authors.lastname: Pérez-Milán
authors.affiliation: Department of Gynecologic Surgery, Gregorio Marañón University General Hospital, Madrid, Spain.
authors.forename: Luís
authors.initials: L
authors.lastname: Ortiz-Quintana
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000077216:Carcinoma, Ovarian Epithelial; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery; D010386:Pelvic Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D010534:Peritoneal Neoplasms / Q000401:mortality / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D012187:Retroperitoneal Space / Q000473:pathology*; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: Ovarian cancer; Retroperitoneal, parametrial invasion; Suprarenal/celiac, inguinal, supraclavicular nodes