Pelvic lymphadenectomy in operative treatment of ovarian cancer

Burghardt, E; Pickel, H; Lahousen, M; Stettner, Haro

doi:10.1016/0020-7292(87)90259-1

Cited by 20 publications

(33 citation statements)

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“…Some prior studies have found an association between systematic node dissection and improved survival. In a retrospective study of 82 patients with stage III disease, Burghardt et al (1986) showed that pelvic lymphadenectomy was associated with an improved survival compared with those patients who did not have a lymphadenectomy. In a retrospective review of 150 epithelial cancer patients based on the Tokai Ovarian Tumor Study Group, Kikkawa et al (1995) found that the performance of a lymphadenectomy was associated with improved survival in a multivariate analysis after controlling for the effects of stage, residual disease, and histological subtype (Hazard Ratio: 0.677; P ¼ 0.0497).…”

Section: Discussionmentioning

confidence: 99%

“…It is unclear whether lymphadenectomy aids in better staging of patients, or whether the procedure itself has therapeutic value by debulking gross and occult disease. Prior retrospective reports support the role of lymphadenectomy in ovarian epithelial cancer (Burghardt et al, 1986;Scarabelli et al, 1995). However, others have not found a benefit associated with systematic lymphadenectomy (Spirtos et al, 1995).…”

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The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

et al. 2007

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The aim of the study is to determine the role of lymphadenectomy in advanced epithelial ovarian cancer. The data were obtained from the Surveillance, Epidemiology and End Results (SEER) program reported between 1988 and 2001. Kaplan -Meier estimates and Cox proportional hazards regression models were used for analysis. Of 13 918 women with stage III -IV epithelial ovarian cancer (median age: 64 years), 87.9% were Caucasian, 5.6% African Americans, and 4.4% Asians. A total of 4260 (30.6%) underwent lymph node dissections with a median number of six nodes reported. For all patients, a more extensive lymph node dissection (0, 1, 2 -5, 6 -10, 11 -20, and 420 nodes) was associated with an improved 5-year disease-specific survival of 26.1, 35.2, 42.6, 48.4, 47.5, and 47.8%, respectively (Po0.001). Of the stage IIIC patients with nodal metastases, the extent of nodal resection (1, 2 -5, 6 -10, 11 -20, and 420 nodes) was associated with improved survivals of 36.9, 45.0, 47.8, 48.7, and 51.1%, respectively (P ¼ 0.023). On multivariate analysis, the extent of lymph node dissection and number of positive nodes were significant independent prognosticators after adjusting for age, year at diagnosis, stage, and grade of disease. The extent of lymphadenectomy is associated with an improved disease-specific survival of women with advanced epithelial ovarian cancer.

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Section: Discussionmentioning

confidence: 99%

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The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

et al. 2007

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“…3 If maximal cytoreduction of peritoneal disease is widely accepted as a major determinant of survival, the therapeutic value of systematic lymphadenectomy in women with ovarian cancer remains controversial, even if it has been shown to be feasible and safe. Retrospective studies have suggested a significant survival advantage following systematic lymphadenectomy; 4,5 however, a prospective randomised clinical trial demonstrated a progression-free survival benefit, but no overall survival benefit, when systematic lymphadenectomy was compared with a selected lymphadenectomy limited to palpable bulky nodes. 6 Additional data are thus needed to explore the value of lymphadenectomy in patients with all-stage ovarian cancer.…”

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The role of lymph node resection in ovarian cancer: analysis of the surveillance, epidemiology, and end results (SEER) database

Rouzier¹,

Bergzoll²,

Brun³

et al. 2010

BJOG

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Objective The therapeutic role of lymphadenectomy on the survival in patients with ovarian cancer is controversial. The aim of this study was to evaluate the survival impact of lymphadenectomy, depending on the disease stage and extent of the surgery.Design The surveillance, epidemiology, and end results (SEER) registry provided ovarian cancer data from 17 registries.Setting Surveillance, Epidemiology, and End Results database.Population The study population comprised 49 783 patients.Methods Survival was studied according to the number of lymph nodes removed, with stratifications on disease stage and extent of surgery.Main outcome measure The 5-year cause-specific survival rate.Results The median follow up for patients alive at the last followup visit was 39 months. The five-year cause-specific survival rates were 37, 62, and 71% for the groups in which no lymph nodes were examined, in which between one and nine nodes were examined, and in which ten or more nodes were examined, respectively (P < 0.001). Avoiding lymphadenectomy was deleterious in all stages of the disease. It was maximal for International Federation of Gynecology and Obstetrics (FIGO) stage-II patients, but there was no significant interaction between stage and extent of lymphadenectomy. The cause-specific survival was found to significantly increase when more nodes were resected, even if the surgical procedure consisted of debulking surgery or a pelvic exenteration.Conclusion Our study suggests a beneficial effect of lymphadenectomy in epithelial ovarian tumours, regardless of the stage of disease and extent of surgery. However, potential biases inherent to this retrospective methodology, such as staging migration, defining the extent of residual disease, and the possibility that thorough lymphadenectomy may reflect the quality of cytoreductive surgery, preclude any formal conclusions on the therapeutic role of lymphadenectomy.

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“…It is important to realize these studies have been done on primarily cytoreduced patients with no preoperative chemotherapy and consequently a nodal positivity rate of 65% (macro and microscopic) has been reported. [7][8][9][10] However in contemporary practice most patients are subjected to interval cytoreduction after neoadjuvant chemotherapy. It is possible the nodal positivity rate may be much lesser obviating the need for nodal dissection as a part of interval cyto reduction.…”

Section: Discussionmentioning

confidence: 99%

Pelvic lymphadenectomy as a component of interval cytoreduction for ovarian cancer: is there a benefit? A pilot study

2017

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Background: Management strategy in ovarian cancer includes a combination of cytoreductive surgery and chemotherapy. Interval cytoreductive surgery has been shown to be oncologically non-inferior to primary cytoreduction with the additional benefit of reduced morbidity. Lymphadenectomy as a component of cytoreductive surgery has been controversial with an unproven therapeutic benefit.Methods: Records of patients with a histological diagnosis of ovarian cancer and treated with interval cytoreduction were evaluated. Disease related, pathological and treatment data collected for analysis.Results: The study included 32 patients with a mean age of 56 years (41-76). Serous papillary tumors (42%) were the predominate histology and the majority were in stage III disease (84%). Optimal cytoreduction was achieved in 93%. The mean nodal harvest was 9.8 nodes with left pelvic dissection yielding slightly more nodes than the right (4.5 vs 5.2). Nodal positivity was observed in just one patient (3%). A total of 314 were nodes examined with only 2 (0.6%) yielding persistent disease. The nodal positivity yield tested as a categorical variable by the binomial test returned P=0.0001.Conclusions: It is possible to omit pelvic nodal dissection during interval cytoreduction in otherwise optimally cytoreduced patients particularly when imaging and intraoperative assessment are not suggestive of pelvic nodal metastasis.

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Pelvic lymphadenectomy in operative treatment of ovarian cancer

Cited by 20 publications

References 0 publications

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

The potential therapeutic role of lymph node resection in epithelial ovarian cancer: a study of 13 918 patients

The role of lymph node resection in ovarian cancer: analysis of the surveillance, epidemiology, and end results (SEER) database

Pelvic lymphadenectomy as a component of interval cytoreduction for ovarian cancer: is there a benefit? A pilot study

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