The initial surgery for women with advanced ovarian cancer aims to remove as much of the tumour as possible. While the resection of bulky nodes has been a part of that procedure, there has been debate about the survival advantage to be gained from including systematic aortic and pelvic lymphadenectomy as part of the initial debulking surgery. The findings of a multi-centre trial that ran for over 12 years in five countries addressing this issue has been published in the Journal of the National Cancer Institute. In the trial 427 women with advanced ovarian cancer were randomly assigned to systematic lymphadenectomy or resection only of bulky nodes following optimal surgical debulking in the peritoneal cavity.

Professor Neville Hacker, Director of the Gynaecological Cancer Centre, Royal Hospital for Women, Sydney, one of the authors of the paper commented, "During the 1980's, the studies of Prof Erik Burghardt at the University of Graz suggested there there may be a therapeutic advantage to the systematic removal of the pelvic and para-aortic lymph nodes in patients with advanced ovarian cancer. Non-randomised studies in Italy tended to confirm this hypothesis, so the appropriate surgery for patients with advanced ovarian cancer became controversial."

Professor Hacker coordinated the international study to address this issue, which has found a modest improvement in disease-free survival for patients having a systematic lymphadenectomy (5-7 months), but no improvement in overall survival. The findings also note morbidity and operating time were increased in patients having systematic lymphadenectomy.

Professor Hacker commented that the clear message from this study is that there is no role for systematic lymphadenectomy in the management of patients with advanced ovarian cancer. As noted in the Clinical practice guidelines for the management of women with epithelial ovarian cancer, any bulk pelvic or para-aortic nodes should be resected, if possible.

Reference: Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomised clinical trial. Journal of the National Cancer Institute 2005; 97(8) 560-6.

Printed in the National Breast Cancer Centre Program Ovarian e-upd@te, May 2005