Objectives To assess the predictive factors of para aortic lymph node metastasis (PAO LNM) in primary epithelial ovarian cancer (EOC).

Methods We retrospectively analyzed the charts of 73 patients with EOC who underwent pelvic and paraaortic lymphadenectomy during a primary (n=62) or secondary debulking surgery (n=11) at the Salah Azaiez institute of oncology between 2000 and 2010.

Results The mean number of retrieved LN was 13.18 (range 4–32) in the pelvic area and 16.53 (range 3–58) in the paraortic area.PAOLNM were recorded in 21 patients (28.8%), pelvic LNM in 18 patients (24.7%) and 17.8% of patients presented pelvic and paraortic LNM.Paraaortic LNM was significantly associated to high tumor grade (40.9% vs 10.3% in low grade,p=0.005),serous subtype (38.5% vs 4.8% in non serous subtype,p=0.004), bilateral tumors (36.6% vs 17.2% in unilateral tumor,p=0.077),the presence of lymphovascular invasion (41.7% vs 22.4%,p=0.088), the presence of carcinomatosis in the upper abdomen (52.6% vs 20.4%,p=0.008), and pelvic lymph node metastasis (66.7% vs 16.4% in case of negative pelvic LN, p<0.0001). Moreover, the mean number of pelvic LNM was significantly higher in patients with PALNM (3.25 ± 3.57 vs 1.83 ± 1.602, p=0.001) and pelvic lymph node ratio (LNR) exceeding 10% was predictive of PAOLNM (75% vs 19.7% in case of pelvic LNR less than 10%, p<0.0001). Bilateral pelvic LNM as well as right positive pelvic LN were associated to a higher rate of PAOLNM.

Conclusions The risk of PAO LNM is correlated to pelvic LN status as well as histological and clinical features of the primary tumor.