Abstract
Original Article pISSN 2005-0380 eISSN 2005-0399 J Gynecol Oncol Vol. 24, No. 1:29-36 http://dx.doi.org/10.3802/jgo.2013.24.1.29 Analysis of para-aortic lymphadenectomy up to the level of the renal vessels in apparent early-stage ovarian cancer Suk-Joon Chang 1 , Robert E. Bristow 2 , Hee-Sug Ryu 1 Department of Obstetrics and Gynecology, Ajou University School of Medicine, Suwon, Korea; 2 Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, Orange, CA, USA Objective: The aim of this study was to evaluate the impact of para-aortic lymphadenectomy up to the renal vessels on the accurate staging in ovarian cancer patients presumed preoperatively to be confined to the ovary. Methods: We retrospectively analyzed data on 124 patients with primary epithelial ovarian cancer who were preoperatively thought to have tumor confined to the ovary and underwent primary staging surgery. The distribution of lymph node meta stasis and various risk factors for nodal involvement were investigated. Results: Surgical staging yielded: 87 (70.2%) patients had International Federation of Gynecology and Obstetrics (FIGO) stage I disease and 37 (29.8%) patients had stage II-III disease: 4 IIA, 6 IIB, 9 IIC, 1 IIIA, and 17 IIIC. Eighty-six patients had pelvic lymphadenectomy only and 69 had pelvic and para-aortic lymphadenectomy. Lymph node metastases were found in 17 (24.6%) of 69 patients; 5 (7.2%) patients had lymph node metastasis in the pelvic lymph nodes only, 8 (11.6%) in the para-aortic lymph nodes only, and 4 (5.8%) in both pelvic and para-aortic lymph nodes. Six (8.7%) patients had lymph node metastasis in the para- aortic lymph node above the level of the inferior mesenteric artery. On multivariate analysis, grade 3 tumor (p=0.01) and positive cytology (p=0.03) were independent predictors for lymph node metastasis. Conclusion: A substantial number of patients with apparently early ovarian cancer had upstaged disease. Of patients who underwent lymphadenectomy, some patients had lymph node metastasis above the level of the inferior mesenteric artery. Para- aortic lymphadenectomy up to the renal vessels may detect occult metastasis and be of help in tailoring appropriate adjuvant treatment as well as giving useful information about the prognosis. Keywords: Early-stage ovarian cancer, Lymph node metastasis, Para-aortic lymphadenectomy INTRODUCTION Ovarian cancer remains one of the major causes of death from the female genital tract malignancy worldwide, and in Received May 23, 2012, Revised Jun 3, 2012, Accepted Jun 5, 2012 Correspondence to Suk-Joon Chang Department of Obstetrics and Gynecology, Ajou University School of Medicine, 206 World cup-ro, Yeongtong-gu, Suwon 443-721, Korea. Tel: +82-31-219-5251, Fax: +82-31-219-5245, E-mail: drchang@ajou.ac.kr Correspondence to Robert E. Bristow Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of California, Irvine School of Medicine, 101 The City Drive, Building 56, Room 260, Orange, CA 92868, USA. Tel: +1-714-456-8000, Fax: +1-714-456- 7754, E-mail: rbristow@uci.edu the United States, 21,990 new cases and 15,460 deaths were estimated in 2011 [1]. Approximately 25% of ovarian cancer patients are diagnosed with early-stage disease at the time of initial treatment [2]. Surgical staging is a critical aspect of early ovarian cancer as well as advanced ovarian cancer because the International Federation of Gynecology and Obstetrics (FIGO) staging based on surgical and pathologic findings is one of the most important prognostic factors [3]. Accurate surgical staging for early-stage ovarian cancer patients has great significance, permitting accurate estimation of the true extent of disease with detection of occult disease, and providing patients with appropriate information about the prognosis and adjuvant treatment. Up to 30% of patients with apparent early-stage ovarian cancer are found to have extra- Copyright © 2013. Asian Society of Gynecologic Oncology, Korean Society of Gynecologic Oncology This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. www.ejgo.org
Highlights
The contemporary Federation of Gynecology and Obstetrics (FIGO) guidelines for ovarian cancer recommend pelvic and para-aortic lymphadenectomy as part of initial surgical staging procedure but do not provide the extent of lymphadenectomy [19], several studies have addressed the potential risk of para-aortic lymph node metastasis above the level of the inferior mesenteric artery (IMA) in apparent early ovarian cancer [7,10,13,14,16,20,21]
In 2012, a Group of European Investigators reported their institutional series on the importance of surgical staging in early ovarian cancer patients [22]
It is very interesting that the pattern of surgical practice for early ovarian cancer has not changed for three decades
Summary
The contemporary FIGO guidelines for ovarian cancer recommend pelvic and para-aortic lymphadenectomy as part of initial surgical staging procedure but do not provide the extent of lymphadenectomy [19], several studies have addressed the potential risk of para-aortic lymph node metastasis above the level of the IMA in apparent early ovarian cancer [7,10,13,14,16,20,21]. The purpose of this study was to evaluate the incidence of pelvic and para-aortic lymph node metastasis, to identify the potential risk of para-aortic lymph node metastasis above the level of the inferior mesenteric artery in patients with ovarian cancer presumed preoperatively to be confined to the ovary, and to assess the clinical relevance of lymphadenectomy as part of the surgical staging procedure
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