Is Routine Nodal Dissection in Early Epithelial Ovarian Cancers Required?

Abstract

The staging of ovarian cancer is unique because it is done surgically, wherein, along with hysterectomy and bilateral oophorectomy, pelvic and para-aortic nodes are routinely removed to find evidence of metastatic disease, which is not detected clinically. With advances in imaging modalities, it is now possible to predict, with reasonable accuracy, whether a regional lymph node is metastatic or not. Hence, in this study we compared the nodal staging in early ovarian cancers (FIGO I) as determined by CT scan (clinical nodal staging) with that of the nodal staging after a staging laparotomy (pathological nodal staging), to determine whether routine lymphadenectomy is justified in all patients with early epithelial ovarian cancer. Apparently early ovarian epithelial tumors were evaluated with contrast-enhanced computed tomography. Patients (n = 39) in whom the ovarian neoplasm appeared malignant and with pelvic and para-aortic nodes less than 10 mm in short-axis diameter and normal morphology were enrolled in the study. All women were subjected to a laparotomy and frozen section of the ovarian mass, followed by a routine staging laparotomy with pelvic and para-aortic nodal dissection, if the frozen section was reported as a malignant ovarian neoplasm. Clinical and pathological nodal staging was compared statistically. Pathological T stage, pathological subtype, grade, and CA-125 levels were also studied to determine whether these variables had an impact on the pathological nodal staging. The difference between clinical nodal staging (as determined by CT scan) and pathological nodal staging is insignificant (p 0.07). Factors, such as pathological T staging, pathological subtype, grade, and CA-125 levels, do not have a significant correlation with pathological nodal staging. Clinical staging of regional nodes, as determined by CT scan, correlates well with the pathological nodal staging in early epithelial ovarian cancer (FIGO I), and hence, a routine lymphadenectomy may not be warranted in all patients.