**6. What is the role of lymphadenectomy in advanced ovarian cancer?**

The goal of surgery in advanced ovarian cancer is to remove all visible disease including a removal of all enlarged lymph nodes. This requires intraoperative assessment of the bilateral pelvic nodes and the para aortic region (pommel type C1–B1).

Given that the nodal basin is considered by some to be relatively chemotherapy insensitive, this to the question whether removal of all involved microscopically and macroscopically involved nodes has a therapeutic benefit.

Panici et al. [21] reported a randomised controlled trial of 268 women with apparent stage IIIB, IIIC/IV cancer. The women were randomised to either resection bulky of pelvic and PA nodes or systematic dissection of the same areas. Positive nodes were found in 42% of the control group and in 42% of the SLD group. No significant difference was recorded in 5 years year overall survival (47 vs. 48.4%). A significant 7-month extension in progression free survival (PFS) was demonstrated (29.4 vs. 22.4 months). The SLD group had a significantly longer operating time, blood loss and blood transfusion. Subsequently, the authors have suggested that the study may be underpowered to detect an overall survival difference.
