13 Pelvic and para-aortic lymphadenectomy in cancer of the ovary

Re, Francesco Lo; Fontanelli, Rosanna; Raspagliesi, Francesco; Re, E. Di

doi:10.1016/s0950-3552(89)80048-3

Cited by 61 publications

(37 citation statements)

References 7 publications

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“…In early stage ovarian cancer, positive nodes can be found in nine to 25% of patients (Baiocchi et al, 1998). Such variabilility is due to the relatively small size of patient series and the heterogeneity of techiques used to detect and remove retroperitoneal nodes which span from simple sampling (Chen and Lee, 1983;Lanza et al, 1988;Carnino et al, 1997) to systematic lymphadenectomy (Di Re et al, 1989;Burghadt et al, 1991;Benedetti Panici et al, 1993;Carnino et al, 1997;Baiocchi et al, 1998). Our findings are in keeping with these data but represent the first direct comparison of the two surgical approaches to retroperitoneal nodes and are not hampered by the methodologic constrains of retrospective analyses.…”

Section: Discussionsupporting

confidence: 69%

“…Lymph node involvement varies according to stage and depends closely on the number of lymph nodes removed and examined. In series of stage I patients undergoing lymph nodes sampling the prevalence ranged from 2% (Tsuruchi et al, 1993) to 4,2% (Carnino et al, 1997) while ranged from 13% (Di Re et al, 1989) to 24% (Burghadt et al, 1991) in series of reported stage I patients undergoing pelvic alone or pelvic and aortic lymphadenectomy. Therefore, the trial was planned to recruit 280 patients to demonstrate a 10% difference in the prevalence of lymph node positivity from 5% in nonlymphadenectomy arm to 15% in lymphadenectomy arm with at least 80% power (using a two-sided test and alpha of 5%).…”

Section: Methodsmentioning

confidence: 94%

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Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

et al. 2006

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No randomised trials have addressed the value of systematic aortic and pelvic lymphadenectomy (SL) in ovarian cancer macroscopically confined to the pelvis. This study was conducted to investigate the role of SL compared with lymph nodes sampling (CONTROL) in the management of early stage ovarian cancer. A total of 268 eligible patients with macroscopically intrapelvic ovarian carcinoma were randomised to SL (N ¼ 138) or CONTROL (N ¼ 130). The primary objective was to compare the proportion of patients with retroperitoneal nodal involvement between the two groups. Median operating time was longer and more patients required blood transfusions in the SL arm than the CONTROL arm (240 vs 150 min, Po0.001, and 36 vs 22%, P ¼ 0.012, respectively). More patients in the SL group had positive nodes at histologic examination than patients on CONTROL (9 vs 22%, P ¼ 0.007). Postoperative chemotherapy was delivered in 66% and 51% of patients with negative nodes on CONTROL and SL, respectively (P ¼ 0.03). At a median follow-up of 87.8 months, the adjusted risks for progression (hazard ratio [HR] ¼ 0.72, 95%CI ¼ 0.46 -1.21, P ¼ 0.16) and death (HR ¼ 0.85, 95%CI ¼ 0.49 -1.47, P ¼ 0.56) were lower, but not statistically significant, in the SL than the CONTROL arm. Five-year progression-free survival was 71.3 and 78.3% (difference ¼ 7.0%, 95% CI ¼ -3.4 -14.3%) and 5-year overall survival was 81.3 and 84.2% (difference ¼ 2.9%, 95% CI ¼ À7.0 -9.2%) respectively for CONTROL and SL. SL detects a higher proportion of patients with metastatic lymph nodes. This trial may have lacked power to exclude clinically important effects of SL on progression free and overall survival.

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Section: Discussionsupporting

confidence: 69%

Section: Methodsmentioning

confidence: 94%

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

et al. 2006

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“…Recently, more attention has been paid to pelvic and para-aortic lymph node metastasis in ovarian carcinoma. In the literature, a number of studies have shown that retroperitoneal area is one of the major sites of metastatic involvement and the average rate of lymph node metastasis in reported stage III is 66% (56-74%) [9][10][11][12][13]. In our study, lymph node metastasis rate was 52.2%.…”

Section: Discussionsupporting

confidence: 53%

Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study

Saygılı

Güçlü

Uslu

et al. 2002

Journal of Surgical Oncology

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“…During the study period in case of a uni-lateral ovarian tumour, a uni-lateral pelvic and para-aortic lymph node dissection was prescribed in our guideline [7,8].…”

Section: Guidelinesmentioning

confidence: 99%

Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome

Sijmons¹,

Lankveld²,

Witteveen³

et al. 2007

European Journal of Obstetrics & Gynecology and Reproductiv

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Objectives: To assess compliance to current surgical staging and adjuvant treatment guidelines for patients with early-stage epithelial ovarian carcinoma and its impact on overall survival. Methods: Patients diagnosed between 1991 and 1997 with early-stage ovarian cancer were recruited from the Regional Cancer Registry of the central region in the Netherlands. Demographic data, tumour characteristics, surgical findings and therapeutic data were abstracted from medical records. Patients were classified into optimal and non-optimal surgical staging. Overall survival was estimated using Kaplan-Meier method. To adjust for age hazard ratios for overall survival were estimated with a Cox Proportional Hazards model. Results: One hundred and twenty-five patients were included in the study, 41 of them (32.8%) were optimally staged. Guidelines for adjuvant radio-or chemotherapy were adequately followed in all 62 grade I patients and in 44 out of 59 grade II and III patients (74.6%). During 734.6 person-years of follow up 31 patients died. Five-year overall survival figures were 97.6% in the optimally staged group and 68.5% in the nonoptimally staged group. Patients who were non-optimally staged, had a significant higher risk to die than those who were optimally staged (HR: 7.4; 95% CI: 1.7-32.2). In patients with a grade II and III tumours, complete surgical staging still had a significant influence on survival (HR: 3.8; 95% CI 1.7-8.3).In women with grade II or III tumours, adjuvant radio-or chemotherapy administered in accordance to the guidelines did not improve overall survival regardless whether they were optimally staged or not. Conclusion: Incomplete staging in early-stage ovarian cancer leads to gross mis-classification in grade II and III tumours and to a lesser extent in grade I tumours. This leads to undertreatment in both surgical and adjuvant therapy. Subsequently unnecessary deaths may occur. More effort must be put in identifying obstacles interfering with compliance of guidelines #

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13 Pelvic and para-aortic lymphadenectomy in cancer of the ovary

Cited by 61 publications

References 7 publications

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis

Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study

Compliance to clinical guidelines for early-stage epithelial ovarian cancer in relation to patient outcome

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