**9. Conclusion**

of vascular anomalies and reduces the risk of collateral damage to structures such as the kidney and ureter. Initial management includes pressure to the area and appropriate communication with the rest of the team including the anaesthetist. Small vascular injuries may be oversewn using a vascular needle and small monofilament suture, ideally avoiding constricting the vessel's diameter. Larger defects require the vascular clamp and the expertise of

The incidence of lymphocyst after the para aortic/pelvic dissection maybe as high as 43% [22]. The vast majority of these will resolve spontaneously and do not require any intervention. Occasionally, a larger lymphocyst may require aspiration typically by interventional radiological drainage. Occasionally, chylous ascites develop in association with an aortic node dissection especially at the level of the renal vessels. This illustrates the importance clipping large lymphatic channels especially in this region. Management of how chylous ascites includes the low-fat diet, the administration of somatosatin and occasionally total parenteral

Other complications associated with lymph node dissection include postoperative ileus, dam-

Serous tubal intraepithelial carcinoma (STIC) is now considered the precursor lesion for high-grade serous cancer [4]. STIC may be an incidental finding in women undergoing a salpingectomy for benign reasons and the incidence is expected to rise in women undergoing risk reducing surgery for ovarian/tubal cancer. The management of women with STIC as an incidental finding it is unclear. It is apparent, the percentage of these women will have disseminated spread of high-grade serious cancer. Based on small series, authors have suggested comprehensive surgical staging including lymphadenectomy [23, 24]. This is relatively a new

Following the Panici study reporting a significant difference in PFS, the role of a full systematic node dissection is the subject of two randomised controlled trials, the Lymphadenectomy

The Lymphadenectomy in Ovarian Neoplasia (LION) study is an AGO randomised controlled trial including women with FIGO stage IIB–IV ovarian epithelial cancer and complete

age to the duodenum, damage to relevant nerves and long-term lymphoedema.

condition with larger case series publication expected over the next few years.

**8. Ongoing research into lymphadenectomy**

in Ovarian Neoplasia (LION) and CURACO trials [21].

**8.1. Early stage ovarian/tubal cancer**

**8.2. Advanced stage cancer**

a vascular surgeon.

nutrition.

**7.2. Lymphocyst formation**

266 Ovarian Cancer - From Pathogenesis to Treatment

**7.3. Other complications**

Spread to the lymphatic system is common in epithelial ovarian cancer is common and is an early event. Para aortic and bilateral pelvic node dissection sampling (Pommel type B1) should be included in surgical staging to determine chemotherapy use and to improve prognosis in ovarian cancer apparently confined to the ovary based on the results of the ACTION trial.

In women with advanced ovarian, the retroperitoneal lymph nodes should be assessed and bulky lymph nodes removed in an attempt to achieve complete cytoreduction. Systematic lymph node (SLN) of the para aortic nodes should not be routinely performed pending the results of the LION and CURACO studies.
