The effect of chemotherapy on lymph node metastases in ovarian cancer.

Twenty-six patients with ovarian cancer underwent pelvic and para-aortic lymphadenectomy at second-look or third-look surgery after complete chemotherapy. The frequency of positive nodes (65.3%) was the same as that found at primary lymphadenectomy. Patients who had received cisplatin had the same frequency of positive nodes as those who had received a schedule which lacked cisplatin. Node involvement was not associated with tumour residual after primary surgery. Survival was strongly associated with nodal status. A difference in survival among patients who underwent primary lymphadenectomy could not be demonstrated. Of all gynaecological malignancies, ovarian cancer has the highest rate of positive retroperitoneal nodes. Chemotherapy, even with cisplatin, seems to have no effect on tumour deposits in the nodes. It cannot be assumed that a cure is possible if disease persists in the lymph nodes after chemotherapy, even if the abdomen has been cleared by radical primary surgery. Thus, cytoreduction should encompass the retroperitoneal space, and lymphadenectomy should be an integral component of the operative treatment of ovarian cancer.