Indicators of systematic lymphadenectomy as a part of surgical management in ovarian carcinoma patients

Abstract

Objective: To identify clinical and pathological indicators that reliably predict lymph node metastasis in patients with ovarian carcinoma, thereby guiding the selective and rational application of systematic pelvic and para-aortic lymphadenectomy as part of their surgical management. Patients and Methods: A total of 150 consecutive patients with epithelial ovarian carcinoma who underwent primary cytoreductive surgery between January 2023 and December 2024 were included in this study. All patients underwent systematic pelvic and para-aortic lymphadenectomy, regardless of preoperative findings. Pathological examination of all the harvested lymph nodes was performed. Clinical indicators (e.g., preoperative CA-125, ascites volume, tumor size, and suspicious imaging nodes) and pathological indicators (e.g., FIGO stage, histological type, tumor grade, and omental/peritoneal metastases) were correlated with confirmed lymph node metastasis. Results: Lymph node metastasis was confirmed in 45% (68/150) of the patients. Significant clinical predictors included preoperative CA-125 level > 500 U/mL (OR=3.5, p=0.002), ascites > 500 mL (OR=2.8, p=0.008), and suspicious imaging nodes (OR=4.1, p<0.001). The pathological indicators strongly correlated with nodal metastasis were advanced FIGO stage (Stage III/IV: OR6.2, p<0.001), high-grade serous histology (OR=3.9, p=0.001), and gross peritoneal metastases (OR=5.5, p<0.001). Systematic lymphadenectomy led to upstaging in 20% (30/150) of the patients with no suspicious nodes on imaging. Conclusion: Several clinical and pathological indicators reliably predicted lymph node metastasis in ovarian carcinomas. Utilizing these indicators can help guide the selective performance of systematic lymphadenectomy, optimizing surgical staging, and personalized adjuvant treatment strategies, while potentially reducing unnecessary morbidity.