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Moreover, none of these patients had unresectable bulky nodes.
Lymphadenectomy is justified to remove bulky nodes or in cases where complete macroscopic debulking has been achieved.
We found that patients who underwent systemic lymphadenectomy had neither OS nor disease-free survival benefits when compared with patients who underwent removal of bulky nodes only.
Benedetti Panici et al (2005) reported the results of a prospective trial on 427 patients with optimally debulked stage IIIB IV epithelial ovarian cancer randomised to systematic pelvic and paraaortic lymphadenectomy vs resection of bulky nodes only.
For example, this could include performing a more limited lymph node dissection following a resection of an involved bulky node, or performing a more extensive nodal dissection in patients without bulky nodes or co-morbidities (Smith et al, 2008).
From January 1991 through May 2001, 308 patients with the International Federation of Gynaecology and Obstetrics stage IA IV epithelial ovarian carcinoma were randomly assigned to undergo SAPL (n=158) or resection of bulky nodes only (n=150).
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To address this question, we re-analysed our data, looking only at cases with non-bulky nodes.
In this study, a microscopically positive lymph node was defined as a node with a size ⩽1 cm, macroscopically positive lymph node a node with a size >1 cm and a bulky positive node a node with a size >2 cm.
In the absence of this or other risk factors for pelvic disease (previous scrotal or inguinal surgery, maldescent, tunica vaginalis invasion, retroperitoneal lymph node dissection or bulky abdominal nodes), routine pelvic CT for patients on surveillance for stage I disease may constitute unnecessary radiation [ 25].
Of seven patients with bulky positives nodes, three patients with bulky paraaortic nodes died of the disease, three of the four patients with bulky pelvic but without bulky paraaortic nodes had no recurrence.
A mass of bulky involved nodes counts the same as a microscopic deposit in one node.
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