[Relevance of surgical lymph node staging for malignant ovarian germ cell tumors]

The purpose of the study was to investigate the relevance of infrarenal paraaortic lymph node staging in the surgical procedure of malignant ovarian germ cell tumors in adults.

84 cases (39 dysgerminoma, 45 nondysgerminatous tumors) were studied by means of a retrospective multicentric survey.

Among the tumors limited to the ovaries, 36 were not completely staged, in particular the infrarenal paraaortic lymph nodes had not been explored. Disease recurred in 6 of these non-staged cases: 3 recurrences arose from the lymph nodes, and 2 patients died. However no recurrence was noted among the 13 patients who underwent complete surgical staging (statistically non-significative). We observed the same tendency among patients with advanced tumors that required complete peritoneal excision: there was no recurrence among the 6 patients having undergone lymph node dissection, whereas recurrence was noted in 2 of the 10 cases without lymph node dissection, one of which resulted in the death of the patient (statistically non-significative).

In order to classify a tumor as stage I, it is essential that infrarenal lymph node dissection be performed, given the frequency of lymphatic involvement. Only then can the patient benefit from conservative surgery, possibly without any further treatment. The prognosis of advanced tumors that call for complete intraperitoneal excision also seems to be improved by retroperitoneal lymph node dissection. It can be carried out secondarily by laparoscopy, in which case chemotherapy can be quickly performed, as this type of surgery causes little morbidity.