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Incidence and location of para-aortic lymph node metastases in gynecologic malignancies
C W Flanagan1, R S Mannel, J L Walker
1University of Oklahoma College of Medicine, Department of Obstretics and Gynecology, Oklahoma City, USA.
Background:
We sought to determine the location of metastases to para-aortic lymph nodes in patients with gynecologic malignancies.
Study Design:
A retrospective chart review was performed for all cases of endometrial, ovarian, and cervical carcinoma in which right and left para-aortic lymph node dissection was done at our institution from 1985 to 1993. Records were assessed for tumor type as well as for presence and location of metastases to para-aortic lymph nodes.
Results:
A total of 315 patients had bilateral para-aortic lymphadenectomy performed at the time of laparotomy as part of staging or therapy for their gynecologic malignancies. A total of 47 patients (15 percent) had metastasis to the para-aortic lymph nodes. Para-aortic metastasis were identified in 22 (30 percent) of 73 patients with ovarian carcinoma, 11 (8 percent) of 141 patients with cervical carcinoma, and 14 (14 percent) of 101 patients sampled. Unilateral left-sided para-aortic node involvement was observed in 13 patients, unilateral right-sided involvement was present in 14 patients, and bilateral involvement occurred in 20 patients. Regarding tumor type or origin, no significant difference was noted in right-sided compared with left-sided para-aortic metastases.
Conclusions:
Our data suggest no difference in the incidence of metastases to right-sided compared with left para-aortic lymph nodes in patients with gynecologic malignancies, emphasizing the need for bilateral evaluation of the para-aortic lymph nodes. This information is important in the clinical staging of gynecologic malignancies and in establishing protocols requiring para-aortic lymph node dissection.