Objectives Our aim was to analyze the prevalence of positive lymph node in presumed early-stage ovarian carcinoma (OC) after systematic lymph node dissection (LND) and the impact in adjuvant chemotherapy.

Methods We evaluated a series of 765 patients with OC who underwent surgical treatment from January 2007 to December 2019. Patients with peritoneal disease and incomplete surgical staging were excluded. All cases had systematic pelvic and paraaortic LND up to the renal vessels. After patient referral to our center, a second surgery for staging was done in 37.8% of cases.

Results A total of 142 cases were ultimately included. The median pelvic and paraaortic lymph nodes (LN) dissected were 30 (range,6–81) and 21 (range,3–86), respectively. Stage shifts after LND and LN metastasis occurred in 8.4% of cases (12/142) – high-grade serous, 11.9% (5/42); clear cell, 16.6% (5/30); endometrioid, 5.1% (2/39); mixed, 0% (0/13); and mucinous, 0% (0/19). Notably, we found clinically suspicious LN (imaging or intraoperative) in 50% of the metastatic LN. Median hospital stay length was 6 days (range,2–33) and 3.6% had grade ≥3 complications. Moreover, 110 (77.6%) patients underwent adjuvant chemotherapy and all cases had indication due to histologic type regardless the result of LN staging. After a median follow-up of 50.7months (range,1–206) we noted 27 (18.9%) recurrences, and the 5-years recurrence free and overall survival were 92.5% and 98.1%, respectively.

Conclusions We found a relatively low rate of lymph node positivity and half of positive cases had clinically suspicious LN. The LN status did not impact the indication of adjuvant chemotherapy.