Lymph node metastasis in grossly apparent clinical stage Ia epithelial ovarian cancer: Hacettepe experience and review of literature

Guldeniz Aksan Desteli,Alp Usubutun,Kunter Yuce,Murat Gultekin,Ali Ayhan

doi:10.1186/1477-7819-8-106

Guldeniz Aksan Desteli, Alp Usubutun + Show 3 more

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https://doi.org/10.1186/1477-7819-8-106

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Abstract

BackgroundLymphadenectomy is an integral part of the staging system of epithelial ovarian cancer. However, the extent of lymphadenectomy in the early stages of ovarian cancer is controversial. The objective of this study was to identify the lymph node involvement in unilateral epithelial ovarian cancer apparently confined to the one ovary (clinical stage Ia).MethodsA prospective study of clinical stage I ovarian cancer patients is presented. Patient's characteristics and tumor histopathology were the variables evaluated.ResultsThirty three ovarian cancer patients with intact ovarian capsule were evaluated. Intraoperatively, neither of the patients had surface involvement, adhesions, ascites or palpable lymph nodes (supposed to be clinical stage Ia). The mean age of the study group was 55.3 ± 11.8. All patients were surgically staged and have undergone a systematic pelvic and paraaortic lymphadenectomy. Final surgicopathologic reports revealed capsular involvement in seven patients (21.2%), contralateral ovarian involvement in two (6%) and omental metastasis in one (3%) patient. There were two patients (6%) with lymph node involvement. One of the two lymph node metastasis was solely in paraaortic node and the other metastasis was in ipsilateral pelvic lymph node. Ovarian capsule was intact in all of the patients with lymph node involvement and the tumor was grade 3.ConclusionIn clinical stage Ia ovarian cancer patients, there may be a risk of paraaortic and pelvic lymph node metastasis. Further studies with larger sample size are needed for an exact conclusion.

Highlights

Lymphadenectomy is an integral part of the staging system of epithelial ovarian cancer
Lymphadenectomy is an integral part of surgical staging and treatment for ovarian cancers, and they have a potential role in both staging and retroperitoneal debulking
The presence of the following factors were used as exclusion criteria for this study: a) Ruptured capsule b) Presence of ascites c) Presence of adhesions with neighboring tissues d) Presence of gross or suspicious tumor on the surface of the capsule e) Suspicious tumoral involvement of the contralateral ovary f) Palpable lymphadenopathy suspicious for tumor metastasis g) Presence of other concomitant cancers or cancers other than primary epithelial ovarian carcinoma h) Patients incompletely staged at an external medical center or laparoscopy performed before admission i) Patients undergoing fertility sparing surgery

Summary

Introduction

Lymphadenectomy is an integral part of the staging system of epithelial ovarian cancer. The extent of lymphadenectomy in the early stages of ovarian cancer is controversial. The objective of this study was to identify the lymph node involvement in unilateral epithelial ovarian cancer apparently confined to the one ovary (clinical stage Ia). Lymphatic node metastasis results in a change from stage I to stage IIIC. There is debate on the extent of lymphadenectomy, in early staged unilateral tumors (confined to only one ovary) [5,6].

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