Systematic para-aortic and pelvic lymphadenectomy in ovarian cancer. A literature review

C. Ciubotaru, I. Negoi, S. Hostiuc, A. Runcanu, M. Beuran

Abstract: Ovarian cancer represents one of the most frequent gynecological malignancies. The risk of developing this malignancy increases with age, especially after menopause. Surgery remains the only potentially curative treatment for early stage ovarian cancer, and it usually consists in salpingo-oophorectomy, omentectomy, peritoneal biopsies, and lymphadenectomy. Some studies revealed that systematic lymphadenectomy in early stage ovarian cancer leads to higher survival rates, while others showed the opposite. Identification of the sentinel ganglion using indocyanine-green, through open or laparoscopic approach, can decrease postoperative morbidity associated with systematic para-aortic lymphadenectomy. In advanced ovarian cancer, the goal is to obtain the absence of residual disease, which increases the overall survival. In this setting, there is an ongoing debate regarding the best method, various authors recommending either systematic para-aortic and pelviclymphadenectomy, or just the resection of bulky masses. After reviewing the available evidence, we may conclude that in patients with ovarian cancer the goal should be complete resection of the malignant disease, including grossly invaded or micrometastatic lymph nodes. Extensive lymphadenectomy contributes to a more precise staging, but more studies are needed to reveal the subgroup of patients who benefit most regarding overall and progression-free survival.
DOI:10.18643/gieu.2017.120

Keywords: ovarian cancer, systematic lymphadenectomy, surgery.