Villet Richard, Salet-Lizee Delphine
Service de chirurgie viscérale et gynécologique, Groupe Hospitalier Diaconesses Croix Saint-Simon, 18, rue du Sergent Bauchat, 75012 Paris.
Bull Acad Natl Med. 2010 Jan;194(1):39-49; discussion 49-50.
Iliac and lumboaortic lymphadenectomy is a frequent component of surgical treatment for ovarian carcinomas. These procedures carry specific risks and have poorly known immunological consequences. Two prospective randomized studies, one informs limited to the pelvis and the other in advanced disease, suggest that lymphadenectomy improves disease-free survival but not overall survival, although these findings are controversial. Modern imaging techniques (CT MRI, PET scan) and per-operative palpation are less sensitive than exhaustive histological examination of excised nodes. If lymphadenectomy is performed, it must be complete, including the external and primary iliac and lumboaortic chains up to the left renal vein, independently of the tumor location, as the lymphatic drainage pathway is difficult to predict in this setting In addition to their diagnostic value, node clearance also has therapeutic value. The risk of lymphatic invasion depends on the disease stage, grade, and histological type. Lymphadenectomy is not necessary for early-stage disease and is only warranted in advanced stages if the surgery is complete or the tumor residue is smaller than one centimeter.
髂血管和腰主动脉旁淋巴结切除术是卵巢癌手术治疗的常见组成部分。这些手术具有特定风险，其免疫学后果尚不清楚。两项前瞻性随机研究，一项局限于盆腔，另一项针对晚期疾病，表明淋巴结切除术可改善无病生存期，但不能改善总生存期，尽管这些发现存在争议。现代成像技术（CT、MRI、PET扫描）和术中触诊比切除淋巴结的详尽组织学检查敏感性更低。如果进行淋巴结切除术，必须完整切除，包括外侧和主要的髂血管及腰主动脉旁淋巴结链直至左肾静脉，与肿瘤位置无关，因为在此情况下淋巴引流途径难以预测。除了其诊断价值外，淋巴结清扫也具有治疗价值。淋巴转移风险取决于疾病分期、分级和组织学类型。早期疾病无需进行淋巴结切除术，只有在晚期且手术完整或肿瘤残留小于1厘米时才值得进行。
