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Int J Gynecol Cancer. 2008 Mar-Apr;18 Suppl 1:7-10.

Management of retroperitoneal lymph nodes in advanced ovarian cancer.

Hacker NF, Valmadre S, Robertson G.
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Management of retroperitoneal lymph nodes in advanced ovarian cancer
N.F. HACKER*, S. VALMADRE* & G. ROBERTSON*
  *Gynaecological Cancer Centre, Royal Hospital for Women, University of New South Wales, Randwick, Australia
Correspondence to  Neville F. Hacker, MD, Gynaecological Cancer Centre, Royal Hospital for Women, University of New South Wales, Locked Bag 2000, Barker Street, Randwick NSW 2031, Australia. Email: n.hacker@unsw.edu.au
Copyright Journal compilation © 2008, IGCS and ESGO
KEYWORDS
advanced ovarian cancer ． lymphadenectomy
Hacker NF, Valmadre S, Robertson G. Management of retroperitoneal lymph nodes in advanced ovarian cancer. Int J Gynecol Cancer 2008;18(Suppl. 1):7–10.

ABSTRACT
Abstract.  
Autopsy studies have demonstrated a very high incidence of positive retroperitoneal lymph nodes in patients with advanced ovarian cancer, but the clinical management of these nodes has only recently been investigated. Several institutional studies had suggested an advantage to systematic removal of pelvic and paraaortic nodes in patients whose tumor was optimally cytoreduced in the peritoneal cavity. However, the only randomized prospective study revealed a 7-month benefit in progression-free survival for patients having systematic lymphadenectomy, but no benefit in terms of overall survival. Unless a future randomized trial shows evidence to the contrary, removal of clinically normal nodes should not be considered part of the standard care for patients with advanced ovarian cancer. Bulky nodes should be removed as part of the surgical aim of removing all macroscopic residual disease.

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Abstract
Objective: To determine the prevalence and incidence of lower limb lymphoedema (LLL) in a cohort of women
who had treatment for gynaecological cancer between May 1995 and April 2000.
Design: A retrospective survey.
Setting: The study took place at an urban referral centre in an Australian tertiary referral women’s hospital.
Sample: The data collection was based on 66% of 743 women on the database of the Gynaecological Cancer Centre.
Methods: Interviews and assessments were conducted to determine the status of lower limbs; medical records were
reviewed for age, weight, site and type of cancer and treatment.
Main outcome measures: Leg swelling, diagnosed lower limb lymphoedema, no swelling of the legs and type of
surgery were determined as the main outcome measures.
Results and conclusions: The diagnosis of lower limb lymphoedema was made in 18% of the total sample: 53%
of these were diagnosed within 3 months of treatment, a further 18% within 6 months, 13% within 12 months and
the remaining 16% up to 5 years following treatment. Women most at risk for developing LLL were those who had
treatment for vulvar cancer with removal of lymph nodes and follow up radiotherapy. For this subsample, the
prevalence was 47%. The finding that LLL occurs within the first year is earlier than hitherto generally believed. It
is therefore imperative for all health professionals to include care and assessment of the legs particularly during the
immediate pre- and postoperative period.
Key words: gynaecology/oncology nursing, lower limb lymphoedema, vulvectomy.

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