The role of pelvic and para-aortic lymphadenectomy in gynecological malignancies
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AbstractObjectives To study the role of pelvic and para-aortic lymphadenectomy in ovarian carcinoma, especially in the early stages in which conventional imaging such as computed tomography and MRI reveal that pelvic and para-aortic lymph nodes were negative. Background Pelvic and aortic nodes are common sites of metastasis from gynecologic malignancies, and there is no question that the evaluation of the lymph node status provides important prognostic information. Materials and methods Between October 2012 and October 2014, 18 patients who were previously untreated and had biopsy-proven ovarian carcinoma were operated upon in the Department of General Surgery, Menoufia University Hospital. The surgical procedure consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, and or omentectomy, in addition to systematic pelvic and para-aortic lymphadenectomy. Results Positive nodes were found in eight patients (44.4%): four pelvic, one aortic, and three both pelvic and aortic metastases. The median number of positive nodes was five pelvic (range 1-12) and four aortic (range 1-6) nodes. The most frequently involved node group with ovarian carcinoma was the obturator group. Conclusion These data may be useful for tailoring lymphadenectomy in relation to the preferred sites of retroperitoneal lymph node metastasis and the median number of nodes resected from each group, and it confirms that systematic pelvic and aortic lymphadenectomy is a feasible procedure and can be performed with acceptable morbidity and no mortality. However, to provide solid evidence that this procedure has a therapeutic benefit, randomized controlled studies are needed.