Management of nodal disease in advanced-stage ovarian cancer: porta hepatis, celiac, pelvic and paraaortic lymphadenectomy

Abstract

Maximal cytoreduction is considered the most important prognostic factor for ovarian cancer survival. Most ovarian cancer patients are diagnosed at an advanced stage, and more than half of them have upper abdominal involvement. Upper abdominal regions alongside the pelvis should be evaluated systematically as a routine procedure during cytoreductive surgery. Therefore, aggressive procedures are adopted during cytoreductive surgery, including upper abdominal regions, to achieve maximal cytoreduction. It should include the exploration of porta hepatis and celiac lymph nodes. The feasibility of metastatic disease resection at the porta hepatis and celiac lymph nodes has been demonstrated in many studies with acceptable morbidity. Furthermore, ovarian cancer often leads to retroperitoneal lymph nodes metastases in patients with advanced stages of the disease. Data from the literature showed that more than half of the advanced-stage ovarian cancer patients had lymph node involvement. In this manuscript, we reviewed the current literature and aimed to investigate the impact on survival of surgical resection of porta hepatis, celiac regions, and pelvic/paraaortic lymph nodes in patients with advanced-stage ovarian cancer. Resection of metastatic disease at the porta hepatis/celiac lymph nodes to achieve maximal cytoreduction is feasible but with a relatively high rate of morbidity and mortality. Randomized controlled trials indicate that in the absence of suspicious lymph nodes, both during surgery and at imaging, systematic lymphadenectomy seems to provide no survival benefit.