The exact role of lymphadenectomy in the management of ovarian cancer has been the object of controversy during recent years. The International Federation of Obstetrics and Gynecology has indicated that pelvic and para-aortic lymph node sampling is an integral part of the staging system of ovarian cancer. On the other hand the advantage of systematic sampling, resection of bulky nodes only, or no lymphadenectomy in terms of recurrence rate and survival of ovarian cancer patients has not yet been clearly defined. Thanks to the analysis of clinical studies on systematic lymphadenectomy, detailed anatomical studies to assess the location of lymph nodes and lymphatic spread have been recently reported. In this chapter we report the available data on clinical anatomy and pathological assessment of lymph node and lymphatic spread of ovarian cancer metastasis; we also review the clinical data on correlation of lymph node metastasis and disease status. Surgical techniques developed during years of dedication to this procedure are also described. Finally, we review and discuss the actual benefits of lymph node dissection in patients with ovarian cancer, analysing previously reported and ongoing trials.