Vol 92, No 12 (2021)
Research paper
Published online: 2021-04-26

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The insolvable problem; survival effect of lymphadenectomy in advanced stage ovarian cancer

Mehmet Sait Bakır1, Özer Birge1, Ceyda Karadag1, Selen Doğan1, Hasan Aykut Tuncer1, Tayup Simsek1
Pubmed: 33914302
Ginekol Pol 2021;92(12):829-836.


Objectives: In this study, we aimed to evaluate the effect of systemic lymphadenectomy on overall and progression free survival in advanced stage of ovarian cancer.
Material and methods: The data of ovarian cancer patients who had been admitted to our clinic between March 2008 and December 2019 were collected retrospectively. The patients who had received neo-adjuvant chemotherapy (NACT), those having undergone interval surgery, those who had non-epithelial ovarian cancer, those with residual tumour larger than 1 cm and those with stage I-IIA were excluded from the study.
Results: A total of 241 patients with inclusion criteria were included in the study. While 169 patients (70.1%) had undergone systemic lymphadenectomy (SLND), 72 (29.9%) had not. Lymph node involvement was present in 105 out of 169 patients (62.1%) who had undergone SLND. There was no statistically significant difference between the groups in terms of SLND and lymph node involvement for both progression free survival (PFS) and overall survival (OS) (p = 0.577, p = 0.493, p = 0.481, p = 0.849 respectively). When subgroup analysis was performed according to the residual tumor amount, we could not find any statistically significant difference in both PFS and OS in terms of SLND and lymph node involvement in R0 (complete resection) group (p = 0.057, p = 0.917, p = 0.106 and p = 0.980 respectively). We found similar results for patients in the R1 (optimal resection) group.
Conclusions: It was found that performing systemic lymphadenectomy had no effect on both progressive and overal survival. It should be kept in mind that the increasing number of malignant lymph nodes removed could have a therapeutic effect in OS. Large numbers of randomized clinical trials are required to enlighten this debatable issue that has been continuing, particularly in the recent two decades.

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  1. Torre LA, Trabert B, DeSantis CE, et al. Ovarian cancer statistics, 2018. CA Cancer J Clin. 2018; 68(4): 284–296.
  2. Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
  3. Burger RA, Brady MF, Bookman MA, et al. Gynecologic Oncology Group. Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med. 2011; 365(26): 2473–2483.
  4. Perren TJ, Swart AM, Pfisterer J, et al. ICON7 Investigators. A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med. 2011; 365(26): 2484–2496.
  5. Ayhan A, Gultekin M, Dursun P, et al. Metastatic lymph node number in epithelial ovarian carcinoma: does it have any clinical significance? Gynecol Oncol. 2008; 108(2): 428–432.
  6. Bois Adu, Quinn M, Thigpen T, et al. 2004 consensus statements on the management of ovarian cancer: final document of the 3rd International Gynecologic Cancer Intergroup Ovarian Cancer Consensus Conference (GCIG OCCC 2004). Annals of Oncology. 2005; 16: viii7–viii12.
  7. Slavchev S, Kostov S, Strashilov S, et al. Relation between type of hysterectomy and survival rate in patients with ovarian cancer - single-center study. Prz Menopauzalny. 2020; 19(3): 111–116.
  8. du Bois A, Reuss A, Harter P, et al. Arbeitsgemeinschaft Gynaekologische Onkologie Studiengruppe Ovarialkarzinom, Groupe d'Investigateurs Nationaux pour l'Etude des Cancers Ovariens. Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials. J Clin Oncol. 2010; 28(10): 1733–1739.
  9. Harter P, Gnauert K, Hils R, et al. Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer. Int J Gynecol Cancer. 2007; 17(6): 1238–1244.
  10. Siegel R, Ma J, Zou Z, et al. Cancer statistics, 2014. CA Cancer J Clin. 2014; 64(1): 9–29.
  11. Aletti GD, Dowdy S, Podratz KC, et al. Role of lymphadenectomy in the management of grossly apparent advanced stage epithelial ovarian cancer. Am J Obstet Gynecol. 2006; 195(6): 1862–1868.
  12. Panici PB, Maggioni A, Hacker N, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst. 2005; 97(8): 560–566.
  13. Harter P, Sehouli J, Lorusso D, et al. A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms. N Engl J Med. 2019; 380(9): 822–832.
  14. Prat J. FIGO Committee on Gynecologic Oncology. Staging classification for cancer of the ovary, fallopian tube, and peritoneum. Int J Gynaecol Obstet. 2014; 124(1): 1–5.
  15. NCCN guideline version4 .2017. Epithelial ovarian cancer/Fallopian Tube cancer/Primary peritoneal cancer.
  16. Paik ES, Lee YY, Lee EJ, et al. Survival analysis of revised 2013 FIGO staging classification of epithelial ovarian cancer and comparison with previous FIGO staging classification. Obstet Gynecol Sci. 2015; 58(2): 124–134.
  17. Berek JS. Lymph node-positive stage IIIC ovarian cancer: a separate entity? Int J Gynecol Cancer. 2009; 19 Suppl 2: S18–S20.
  18. Zhou J, Zhang WW, Zhang QH, et al. The effect of lymphadenectomy in advanced ovarian cancer according to residual tumor status: A population-based study. Int J Surg. 2018; 52: 11–15.
  19. Eoh KJ, Lee JY, Yoon JW, et al. Role of systematic lymphadenectomy as part of primary debulking surgery for optimally cytoreduced advanced ovarian cancer: Reappraisal in the era of radical surgery. Oncotarget. 2017; 8(23): 37807–37816.
  20. Zhou J, Shan G, Chen Y. The effect of lymphadenectomy on survival and recurrence in patients with ovarian cancer: a systematic review and meta-analysis. Jpn J Clin Oncol. 2016; 46(8): 718–726.
  21. Gao J, Yang X, Zhang Y. Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies. Jpn J Clin Oncol. 2015; 45(1): 49–60.
  22. Chiyoda T, Sakurai M, Satoh T, et al. Lymphadenectomy for primary ovarian cancer: a systematic review and meta-analysis. J Gynecol Oncol. 2020; 31(5): e67.
  23. Abe A, Furumoto H, Irahara M, et al. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res. 2010; 36(5): 1023–1030.
  24. Wang Y, Ren F, Song Z, et al. Prognostic Significance of Systematic Lymphadenectomy in Patients With Optimally Debulked Advanced Ovarian Cancer: A Meta-Analysis. Front Oncol. 2020; 10: 86.
  25. Lin Q, Liu W, Xu S, et al. The value of systematic lymphadenectomy during debulking surgery in the treatment of ovarian cancer: a meta-analysis of randomized controlled trials. J Ovarian Res. 2020; 13(1): 56.