Significance Of Systematic Pelvic And Para-Aortic Lymphadenectomy In Epithelial Ovarian Carcinoma (Eoc).

5009 Background: To assess the significance of systematic pelvic and paraaortic lymphadenectomy (SLA) up to the upper level of renal vein in EOC. Methods: Between 1/89 and 12/98, 359 consecutive patients (pts) with apparent stage I to IIIC EOC received SLA at the initial surgical attempt in addition to hysterectomy, bilateral adnectomy, omentectomy with or without more extensive surgery including intestinal resections. Six cycles of platinum-based regimens (CAP/TP) were given in pts with stage IC to IIIC EOC and at least 3 cycles of the platinum-based regimens were administered in pts with stage IB or grade 2 or 3 stage IA EOC. Survival distributions were estimated using the Kaplan-Meier method. Results: Significant complications associated with SLA were observed in less than 10% of pts. Lymph node (LN) involvement was observed in 17% (25/148) in pT1, 42% (14/33) in pT2, and 55% (97/178) in pT3 EOC. Five-year survival of pts by pT category was 98% for pT1N0M0 vs 74% for pT1N1M0 (p=0.0000), 79% for pT2N0M0 vs 75% for pT2N1M0 (p=0.897), and 36% for pT3N0M0 vs 31% for pT3N1M0 (p=0.816), respectively. Thus, LN involvement worked as a significant prognostic factor in apparent stage I (pT1) EOC, but it did not function in stage II or III EOC. Five-year survival was 92% for 148 pts with apparent stage I (pT1) EOC receiving SLA and 81% for 69 pts with pT1 without SLA but receiving the same platinum-based regimens who were treated before 1989 (p=0.0064). Pts with pT1N1M0 EOC, who were upstaged to stage IIIC according to the FIGO staging system, had a significantly better 5-year survival (74%) than those with pT3NanyM0 (32%) EOC. Conclusions: SLA is valid in apparent stage I EOC to find pts with worse prognosis, but it may be unnecessary at the initial surgical attempt for apparent stage II or III EOC pts in terms of both diagnosis and treatment. Regarding the FIGO staging system, retroperitoneal stage IIIC (pT1N1M0) should be separately defined from abdominal stage IIIC (pT3NanyM0) EOC which brings worse prognosis. No significant financial relationships to disclose.