Value of Lymphadenectomy

FIGO stage

Intra-abdominal residual disease

Radiological and clinically negative LN

Positive lymph nodes >1 cm

FIGO I–II

>0: stop doing surgery for ovarian cancer

Yes

Complete surgical staging

−/−

FIGO III–IV

Yes or No?

Yes

LN >1 cm ≥TE/LNE

→Reduction of residual disease

1–10 mm

Yes or No?

Yes

LN >1 cm ≥TE/LNE

→Reduction of residual disease

>10 mm

LN lymph node, TE tumor extirpation, LNE lymphadenectomy

Data from prospectively randomized trials evaluating the potential role of systematic lymphadenectomy in advanced ovarian cancer and complete intraperitoneal resection are still pending (LION trial; ClinicalTrials.gov Identifier: NCT00712218; CARACO trial; ClinicalTrials.gov Identifier: NCT01218490).

Table of risk of lymph nodes involvement correlated to FIGO stage.

Authors (years)	n	FIGO stage	Risk of lymph nodes involvement (%)
Takeshima (2007)	208	I	20/156 (13 %)
		II	18/37 (49 %)
		III	9/15 (60 %)
Neigishi (2004)	150	I	8/123 (6.5 %)
Neigishi (2004)	150	II	11/27 (41 %)
Morice (2003)	276	I	17/85 (20 %)
		II	6/15 (40 %)
		III–IV	99/176 (62.5 %)
DiRe (1996)	448	II	17/56 (30.4 %)
		III	142/461 (31 %)
		IV	35/88 (77 %)
Onda (1996)	110	I	7/33 (21.2 %)
		II	6/26 (23.1 %)
		III	29/43 (67.4 %)
		IV	6/8 (75 %)
Burghardt (1991)	180	I	9/37 (24.3 %)
		II	7/14 (50 %)
		III	84/114 (73.7 %)
		IV	11/15 (73.3 %)

References

Wagner U, Harter P, Hilpert F, et al. S3-guideline on diagnostics, therapy and follow-up of malignant ovarian tumours: short version 1.0 – AWMF registration number: 032/035OL, june 2013. Geburtshilfe Frauenheilkd. 2013;73(9):874–89.CrossRefPubMedPubMedCentral

Lhommé C, Morice P, Planchamp F, et al. Clinical practice guidelines 2008 for the surgical treatment, medical first-line and consolidation treatments of patients with epithelial ovarian cancer–update. According to the methodology of Standards, Options: Recommendations (SOR). Bull Cancer. 2008;95(9):881–6.PubMed

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