Controversies in the management of ovarian cancer--pros and cons for lymph node dissection in ovarian cancer. 2009

Oumar Camara, and Jalid Sehouli
Department of Gynaecology and Obstetrics, Friedrich Schiller University, D-07740 Jena, Germany. oumar.camara@med.uni-jena.de

Up-front maximal surgical effort towards cytoreduction with the primary goal of maximum tumour resection is one of the cornerstones in the multimodal management of ovarian cancer. Despite the prognostic relevance of lymph node metastasis, there is a great debate about the role of pelvic and para-aortic lymph node dissection. In early-stage ovarian cancer, lymph node dissection is required to make an accurate clinical staging according to the FIGO classification and to select adequate adjuvant therapy. The effect of lymph node dissection on progression-free survival and overall survival in patients with advanced ovarian cancer is still unknown. There has only been one randomized trial which favoured systematic lymph node dissection instead of lymph node sampling due to significantly better progression-free survival, but there was no difference in overall survival. Patients with postoperative tumour residuals are unlikely to benefit from this procedure. The German AGO has now initiated the first study in advanced ovarian cancer (LION) which compares the value of systematic lymph node dissection with no lymph node resection in patients without any visible tumour residuals. Until these data are in fact available, patients with advanced ovarian cancer should be informed in detail about the pros and cons of systematic lymph node dissection.

UI MeSH Term Description Entries
D008197 Lymph Node Excision Surgical excision of one or more lymph nodes. Its most common use is in cancer surgery. (From Dorland, 28th ed, p966) Lymph Node Dissection,Lymphadenectomy,Dissection, Lymph Node,Dissections, Lymph Node,Excision, Lymph Node,Excisions, Lymph Node,Lymph Node Dissections,Lymph Node Excisions,Lymphadenectomies,Node Dissection, Lymph,Node Dissections, Lymph
D008207 Lymphatic Metastasis Transfer of a neoplasm from its primary site to lymph nodes or to distant parts of the body by way of the lymphatic system. Lymph Node Metastasis,Lymph Node Metastases,Lymphatic Metastases,Metastasis, Lymph Node
D010051 Ovarian Neoplasms Tumors or cancer of the OVARY. These neoplasms can be benign or malignant. They are classified according to the tissue of origin, such as the surface EPITHELIUM, the stromal endocrine cells, and the totipotent GERM CELLS. Cancer of Ovary,Ovarian Cancer,Cancer of the Ovary,Neoplasms, Ovarian,Ovary Cancer,Ovary Neoplasms,Cancer, Ovarian,Cancer, Ovary,Cancers, Ovarian,Cancers, Ovary,Neoplasm, Ovarian,Neoplasm, Ovary,Neoplasms, Ovary,Ovarian Cancers,Ovarian Neoplasm,Ovary Cancers,Ovary Neoplasm
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man

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