**5. Conclusions**

Even in cases with presumed early stage ovarian cancer, a certain number of cases present lymph node metastases. Therefore, in such cases, the patients will be automatically upstaged and the therapeutic strategy will be modified. According to our study, the risk of developing para-aortic lymph node metastases seems to be significantly correlated with the serous histology as well as with a poorer degree of differentiation. Other factors that have been proven to modify this risk are represented by the FIGO stage, age at diagnosis and menopausal status. However, in our study none of these parameters seemed to significantly influence the risk of positive para-aortic lymph nodes. However, larger studies are still needed in order to provide a better identification of cases at risk of developing distant lymph node metastases.

**Author Contributions:** N.B., M.V., S.D., M.D., I.B. performed the surgical procedure, M.V.; A.F. and S.D. reviewed literature data; I.B., C.D., L.I. prepared the draft of the manuscript; I.B. was advisor of the surgical oncology procedures; I.B. reviewed the final version of the manuscript. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Acknowledgments:** This work was supported by the project entitled "Multidisciplinary Consortium for Supporting the Research Skills in Diagnosing, Treating and Identifying Predictive Factors of Malignant Gynecologic Disorders", project number PN-III-P1-1.2-PCCDI2017-0833.

**Conflicts of Interest:** The authors have no conflicts of interest to declare regarding this study.
