The aim of the study was to investigate the incidence of nodal involvement and to identify the role of systematic para-aortic lymphadenectomy in the management of epithelial ovarian cancer.

Between June 1995 and May 2004, 116 women with epithelial ovarian cancer who undertook optimal debulking surgery and para-aortic lymph node sampling or lymphadenectomy were investigated.

The frequency of lymph node metastases according to the stage of disease (clinical stage I, II and III+IV) were 14.6% (6/41), 52.2% (12/23) and 75.0% (39/52), respectively. In patients with stage Ia, Ib and Ic disease, the rates of nodal involvement were 11.8% (2/17), 0% (0/2), and 18.1% (4/22), respectively. None of 2 patients with stage I and grade I had nodal involvement. None of 12 patients with mucinous tumors and none of 6 patients with endometrioid tumors confined to the ovary (stage I) had nodal involvement. Among 116 patients, para-aortic lymph node sampling was performed on 74 patients and systematic para-aortic lymphadenectomy was performed on 42 patients. No significant difference in progression free survival in patients with early stage between two groups, lymphadenectomy vs. node sampling. However, patients with advanced stage who undertook systematic para-aortic lymphadenectomy showed the better progression free survival than patients who undertook para-aortic lymph node sampling (p=0.040). In patients who had lymph node metastasis, lymphadenectomy group showed more significant better survival than lymph node sampling group (p=0.019).

Pelvic and para-aortic lymphadenectomy is important in surgical staging in ovary cancer, but could be omitted in patients with apparent stage I mucinous and endometrioid disease, and stage I grade I epithelial tumor. Systematic para-aortic lymphadenectomy may enhance progression free survival rate in advanced stages but not in early stages in the patients with optimal cytoreduction.