I have thought if patient with ovarian cancer needs compulsorily lymph node ressection when surgery is performed after neoadjuvant chemotherapy or of rescue once disease is already advanced and para aortic and pelvic lymph node ressection increase morbidity to surgery process.
Dear Dr Batista
prophylactic lymph node dissection of para arotic & iliac obturator region is a part of comprehensive ovarian cancer surgery if tumor in abdominal cavity is
There is no evidence-based answer to your question.
The only RCT on advanced stage Ovarian cancer does not demonstrate a survival advantage but is conducted on patients upfront operated (http://www.ncbi.nlm.nih.gov/pubmed/15840878)
After Nact, If there is not preoperative radiological evidence or intraoperative finding of nodal involvement we do not routinely perform surgical nodal staging.
NCCN Guidelines Version 2.2013 Ovarian Cancer
NCCN Guidelines Index Ovarian Cancer TOC Discussion
Comprehensive surgical staging should still be performed to rule out occult higher-stage disease, because data show that approximately 30% of patients undergoing complete staging surgery are upstaged.111 In early-stage disease, minimally invasive techniques to achieve the surgical goals may be considered in selected patients if performed by an experienced gynecologic oncologist.84 Minimally invasive techniques may be considered for prophylactic salpingo-oophorectomy.
mass should be removed intact, if possible. All involved omentum should be removed. Suspicious and/or enlarged nodes should be resected, if possible.120,121 Those patients with tumor nodules, outside the pelvis, of 2 cm or less (presumed stage IIIB) should have bilateral pelvic and para-aortic lymph node dissection (see Principles of Primary Surgery in the NCCN Guidelines for Epithelial Ovarian Cancer). For young patients who will abruptly enter menopause after surgery, various supportive care measures are available to decrease hot flashes and other symptoms.122-124
Cytoreductive surgery is the initial treatment recommendation for patients with clinical stage II, III, or IV disease (see Primary Treatment in the NCCN Guidelines for Epithelial Ovarian Cancer).66,107,111-114 Although cytoreductive surgery is the standard of care, this recommendation is based on retrospective data (and thus is not a category 1 recommendation).115 In general, the following procedures (outlined in the next paragraph) should be part of the surgical management of patients with ovarian, Fallopian tube, or primary peritoneal cancer in an effort to fully stage and to achieve maximal cytoreduction to less than 1-cm residual disease or resection of all visible disease in appropriate circumstances.116-118 Surgical cytoreduction is optimal if the residual tumor nodules are less than 1 cm in maximum diameter or thickness;104,107,115,119 extensive resection of upper abdominal ovarian metastases is recommended for patients who can tolerate this surgery.113
Dear Habibollah Mahmoodzadeh
I think the question is referred to patients undergoing NACT not at newly diagnosed patients.
Dear Violante Di Donato
Really, question is about surgical treatment in patients with advanced ovary cancer who were prior treated with NACT to posterior cito-reduction or those in which primary surgery did not get optimal resection.
Dear Dr.Batista. its regarding the removal of lymphnodes after NACT, prophyactically lymphadenectomy is required if the tumour mass is more than of 2cm size in the pelvic region.