title: Recurrent ovarian cancer with multiple lymph nodes metastases successfully treated with lymphadenectomy as secondary cytoreductive surgery: A case report.
abstract: BACKGROUND
  Occasionally, lymph node metastases represent the only component at the time of recurrence of ovarian cancer. Here we report the case of a 78-year-old Japanese female who underwent successful surgery for recurrent ovarian cancer with multiple lymph node metastases.
  
  
  METHODS
  The patient was referred to our institution with recurrent disease accompanied by chemoresistant multiple retroperitoneal lymph node metastases five years after the initial therapy for stage IIIc serous adenocarcinoma of the ovary. Positron emission tomography/computed tomography (PET/CT) revealed the involvement of two para-aortic nodes and two pelvic nodes, with no other positive site. The patient underwent systematic para-aortic and pelvic lymphadenectomy, and the metastatic nodes were completely resected. Histopathological examination revealed metastatic high-grade adenocarcinoma in four of 63 dissected lymph node specimens. The patient has been in clinical remission for over four years without any further additional therapies.
  
  
  CONCLUSIONS
  In our case, the metastatic nodes predicted by PET/CT completely corresponded to the actual metastatic nodes; however, PET/CT often fails to identify microscopic disease in pathological positive nodes. We cannot reliably predict whether lymph node metastasis will persist in the limited range. Therefore, systematic lymphadenectomy with therapeutic intent should be performed, although it does not always mean that we remove all cancer cells.
  
  
  CONCLUSIONS
  The findings from this case suggest that, even if used as secondary cytoreductive surgery in the context of a recurrent disease, systematic aortic and pelvic node dissection might sometimes contribute to the control if not cure of ovarian cancer.
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan. Electronic address: naganoog@dnh.twmu.ac.jp.
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Nagano
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
authors.forename: Mitsue
authors.initials: M
authors.lastname: Muraoka
authors.affiliation: Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo 116-8567, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Takagi
keywords: Ovarian cancer; Paraaortic lymphadenectomy; Pelvic lymphadenectomy; Secondary cytoreductive surgery