LYMPHADENECTOMY FOR EARLY OVARIAN CANCER In 1988, the International Federation of Gynecology and

Obstetrics (FIGO) published a surgical staging scheme for ovarian cancer that included pelvic and para-aortic lymph node sampling or lymphadenectomy. However, few studies have shown any benefit of lymphadenectomy in patients with early stage disease. Systematic lymphadenectomy may increase surgical morbidity, although it is necessary for accurate staging and has diagnostic value. Recently, Chan et al. [1] conducted a large-scale, retrospective study to assess the impact of lymphadenectomy on survival in patients with clinical stage I ovarian cancer and suggested that lymphad-enectomy significantly improved the survival of such patients. In addition, a randomized study was conducted to investigate the effect of systematic lymphadenectomy in patients with pT1 and pT2 ovarian cancer [2], which showed that systematic lymphadenectomy had no influence on either progression-free survival or overall survival. Tumor involvement of pelvic lymph nodes has been reported to occur in 5%-14 % of pa-tients with pT1 disease and the para-aortic nodes are involved in 4%-12 % (Table 1) [3-9]. Lymphatic spread of early stage ovarian cancer upstages the patient to FIGO stage III, making them appropriate candidates for adjuvant chemotherapy after surgery. The accurate assessment of lymph node metastasis and, therefore, accurate staging of the tumor may be the main value of systematic lymphadenectomy. Also, when the initial surgical staging is correct, patients with low-risk disease may be spared from undergoing cytotoxic chemotherapy. According to the data from the Japan Society of Obstetrics and Gynecology tumor registry (2012), pelvic and para-aortic node dissection are currently performed only for about 40% of patients with early stage ovarian cancer in Japan. Surgical treatment of ovarian cancer, including systematic lymphad-enectomy, should be performed only at gynecologic oncology specialized institutions in order to ensure accurate staging of the tumor. I think that lymphadenectomy is essential to allow accurate assessment of the tumor stage in all patients even with clinically early stage ovarian cancer