Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial

Panici, Pierluigi Benedetti; Maggioni, Angelo; Hacker, Neville F.; Landoni, Fabio; Ackermann, S.; Campagnutta, E; Tamussino, Karl; Winter, Raimund; Pellegrino, A.; Greggi, Stefano; Angioli, Roberto; Manci, Natalina; Scambia, Giovanni; Dell’Anna, Tiziana; Fossati, Roldano; Floriani, Irene; Rossi, R; Grassi, Roberto; Favalli, G.; Raspagliesi, Francesco; Giannarelli, Diana; Martella, Luca; Mangioni, Costantino

doi:10.1093/jnci/dji102

Cited by 428 publications

(249 citation statements)

References 17 publications

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“…Our results contrast with findings of a randomised controlled trial. 6 Further studies are warranted to determine if our finding is related to a 'better staging' effect, a 'marker of more adequate surgery' effect, or a therapeutic effect of lymphadenectomy. Results of this study cannot be regarded as conclusive because of the bias inherent to the retrospective methodology, including stage migration and the possibility that the extent of lymphadenectomy is a surrogate marker for the radicality of surgery.…”

Section: Resultsmentioning

confidence: 91%

“…After stratification for this factor, we obtained similar results: the positive effect of lymphadenectomy was observed regardless of the extent of surgery. In the study by Beneditti Panici et al, 6 when residual disease was taken into account, the hazard ratios for occurrence of the first event and mortality from any cause were almost unchanged. In the Scotroc study including 1077 patients from the UK (n = 689) and other countries (Europe, United States, and Australia; n = 388), UK patients with no visible residual disease had a less favourable progression-free survival rate compared with patients recruited from non-UK centres who were similarly debulked (HR = 1.85; 95% CI = 1.16-2.97; P = 0.010).…”

Section: Discussionmentioning

confidence: 95%

“…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. Recently, Chan et al have performed two large population-based studies to investigate the role of lymphadenectomy in patients with advanced-stage ovarian cancers.…”

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confidence: 99%

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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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Section: Resultsmentioning

confidence: 91%

Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

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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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“…Although systematic lympadenectomy is beneficial for patients with clear cell carcinoma, in advanced stage patients who had had optimal debulking, systematic lympadenectomy did not further improve overall survival or disease-free survival in these patients (Abe et al, 2010). In a study conducted by Panici et al with 419 stage III, and IV patients who had undergone systematic lympadenectomy or only bulky lymph node dissection, in patients with advanced stage optimal debulking, systematic lympadenectomy had not changed overall survival, but improved disease-free survival when compared with bulky node excision (Panici et al, 2005). In the present study, the presence of lymph node involvement did not affect 2-year survival, but it demonstrated an unfavorable effect on 2-year survival.…”

Section: Discussionmentioning

confidence: 94%

Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma

Arikan¹,

Kasap²,

Yetimalar³

et al. 2014

Asian Pacific Journal of Cancer Prevention

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“…There is an increased tendency for nodal invasion in advanced ovarian cancer (1,2). Panici et al described a positive prognostic effect of systematic lymphadenectomy on progression-free survival (PFS) compared with resection of bulky nodes, but not on overall survival (OS) (3). By contrast, other studies reported a positive prognostic effect on OS after systematic lymphadenectomy in this subgroup (4).…”

Section: Introductionmentioning

confidence: 99%

Prevalence and distribution pattern of nodal metastases in advanced ovarian cancer

Bachmann

Bachmann²,

Kraemer

et al. 2016

Molecular and Clinical Oncology

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Abstract. The objective of this study was to examine the relevance of pelvic and para-aortic lymph node involvement and the tumour characteristics affecting nodal metastases and survival in primary advanced ovarian cancer. A total of 130 consecutive patients were retrospectively investigated. All the patients received stage-related surgery with pelvic and para-aortic lymphadenectomy. The median follow-up was 53.5 months. The clinicopathological parameters and distribution pattern of nodal metastases were evaluated. Lymph node metastases were detectable in 74.62% of the cases. Overall, both pelvic and para-aortic nodes were affected in 35.9% of the patients, whereas 13.3% had metastases only in the pelvic and 13.3% only in the para-aortic lymph nodes. Histological grade 1/2 and 3, serous and endometrioid histology were independent predictors of nodal metastasis. Serous and endometrioid cancers have shown a predilection for metastasis to the pelvic lymph nodes alone, both to the pelvic and the para-aortic nodes, or the para-aortic nodes alone. Overall survival was significantly positively affected by serous histology with positive nodes (P=0.043). It is crucial to investigate the risk factors and metastatic patterns of such patients in a multicenter analysis to evaluate individual subgroups. Prospective studies are required to investigate the prognostic effect of lymphadenectomy in advanced ovarian cancer and its association with histology and distribution pattern of nodal metastasis.

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Systematic Aortic and Pelvic Lymphadenectomy Versus Resection of Bulky Nodes Only in Optimally Debulked Advanced Ovarian Cancer: A Randomized Clinical Trial

Abstract: Systematic lymphadenectomy improves progression-free but not overall survival in women with optimally debulked advanced ovarian carcinoma.

Cited by 428 publications

References 17 publications

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

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

Impact of Prognostic Factors on Survival Rates in Patients with Ovarian Carcinoma

Prevalence and distribution pattern of nodal metastases in advanced ovarian cancer

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