Lymphadenectomy in stage I ovarian cancer

Our experience with systematic lymphadenectomy in stage I ovarian cancer (defined as intraabdominal disease confined to the ovaries) was reviewed. We analyzed whether it would be possible to predict lymph node metastases on the basis of clinical-morphologic factors at the time of surgery.

Forty of 100 evaluable patients operated on between 1980 and 1990 underwent comprehensive surgical staging, including total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and systemic pelvic +/- paraaortic lymphadenectomy.

Nine of the 40 (23%) patients who underwent lymphadenectomy were found to have lymph node metastases; five of these were < or = 2 mm in maximum diameter. Four of the nine patients with positive nodes had ovarian tumors with a maximum diameter of only 5 cm, eight had grade 2 or 3 tumors, and eight tumors were classified as serous cystadenocarcinomas. Other clinical-morphologic factors such as ascites, adherence, or extracystic excrescences did not predict lymph node metastasis. Four of the nine patients with positive nodes survived > or = 5 years with no evidence of disease.

Lymph node metastases, some < r = 2 mm in diameter, occur in an appreciable percentage of patients with intraabdominal disease confined to the ovaries. Clinical-morphologic factors at surgery cannot be relied on to predict the status of the lymph nodes. Thus we cannot recommend limiting lymphadenectomy to any specific subgroup of patients with intraabdominal disease confined to the ovaries.