Management of Advanced Ovarian Cancer

Abstract

Since the end of 1979, extensive pelvic lymphadenectomy has been performed at the Graz University Clinic of Obstetrics and Gynecology in the operative treatment of ovarian cancer in stages IB to IV. In 27 of 48 patients (56.3 per cent) positive nodes were found. As shown in Table 1, positive nodes were found in all stages from stage IB onwards. The staging was done prior to lymphadenectomy; otherwise, all early stages with positive nodes would have to be included in stage III. Of special interest is the primary stage III in 36 cases thus comprising the most representative number. In this stage more than 60 per cent of positive nodes occurred. In 12 cases lymphadenectomy was done in second-look laparotomy. It became apparent that after operative and cytotoxic treatment with Adriamycin (Adria Laboratories, Inc., Dubin, OH), cisplatin, and cyclophosphamide pelvic lymph nodes were still found positive in 8 of 12 cases (66.7 per cent). In 16 cases apart from pelvic lymphadenectomy paraaor-tic nodes were also assessed. Enlarged nodes were extirpated when technically possible and when the patient's intraoperative condition would allow it. Thus, three cases were also recorded in which the nodes seemed positive but only by palpation. Even when including these cases the incidence of positive paraaortic nodes was clearly lower in all stages than that of pelvic nodes. Paraaortic nodes were positive only in cases of involved pelvic lymph nodes. When pelvic nodes were, negative, there were also no positive paraaortic nodes. The therapeutic value of pelvic lymphadenectomy must be evaluated critically as the number of cases is still rather small. In Table 2 two groups are compared. The first comprises cases after maximal debulking without lymphadenectomy but postoperative chemotherapy according to Parker and Lloyd. At the time of second-look laparotomy, 72.7 per cent of patients with a previously positive lymphadenectomy were tumor free; however, in those patients with negative lymph nodes, 100 percent showed no residual tumor (excepting one case of embryonic cancer) (Table 3). When considering the primarily excised nodes in 35 cases, only 22 out of 86 positive nodes or 26 per cent belonged to the common iliac group, 39 or 45 per cent to the external iliac nodes while 23 nodes or 27 per cent belonged to the interiliac group.