The Role of Lymphadenectomy in Ovarian Epithelial Cancer

Abstract

High-grade serous ovarian/tubal cancer commonly spreads via the peritoneal and lym- phatic routes. This chapter discusses the anatomical lymphatic drainage of the ovary and tube with reference to spread from different epithelial ovarian cancer types. The role of lymph node surgery in apparent early stage curative disease will be discussed with reference to staging and directing the need for adjuvant chemotherapy. In advanced disease, the role of lymph node sampling versus systematic dissection surgery as part of cytoreduction is assessed. The result of two randomised controlled trials (RCTs) published on the subject will be analysed along with the ongoing Lymphadenectomy in Ovarian Neoplasia (LION) study. The chapter adopts an evidence-based approach to the role of lymph node surgery in women with epithelial ovarian/tubal cancer. No significant difference was recorded in 5 years year overall survival (47 vs. 48.4%). A significant 7-month extension in progression free survival (PFS) was demonstrated (29.4 vs. 22.4 months). The SLD group had a significantly longer operating time, blood loss and blood transfusion. Subsequently, the authors have suggested that the study may be underpowered to detect an overall survival difference.