Ebina Y, Yamagami W, Kobayashi Y, et al. - Lymph node dissection can be skipped in the initial surgery for granulosa cell tumors (GCTs) if the operative finding is pT1. Considering lymph node dissection in cases of pT2 or higher is recommended. Debulking is important to make sure there is no gross residual tumor at the end of the surgery.

• This was an observational retrospective cohort study involving Japanese women with GCTs.

• A total of 1,426 patients with GCTs were examined.

• 222 patients had lymph node dissection, of those 10 (4.5%) had lymph node metastasis.

• In cases with pT1, pT2, and pT3, incidence of lymph node metastasis was 2.1%, 13.3%, and 26.7%, respectively.

• Independent risk factors for cancer-specific survival included residual disease after initial surgery (hazard ratio (HR) = 10.39) and lymph node metastasis (HR = 5.58).