Systematic lymphadenectomy in ovarian cancer at second-look surgery: a randomised clinical trial

Abstract

Background:The role of systematic aortic and pelvic lymphadenectomy (SAPL) at second-look surgery in early stage or optimally debulked advanced ovarian cancer is unclear and never addressed by randomised studies.Methods:From January 1991 through May 2001, 308 patients with the International Federation of Gynaecology and Obstetrics stage IA–IV epithelial ovarian carcinoma were randomly assigned to undergo SAPL (n=158) or resection of bulky nodes only (n=150). Primary end point was overall survival (OS).Results:The median operating time, blood loss, percentage of patients requiring blood transfusions and hospital stay were higher in the SAPL than in the control arm (P<0.001). The median number of resected nodes and the percentage of women with nodal metastases were higher in the SAPL arm as well (44% vs 8%, P<0.001 and 24.2% vs 13.3%, P:0.02). After a median follow-up of 111 months, 171 events (i.e., recurrences or deaths) were observed, and 124 patients had died. Sites of first recurrences were similar in both arms. The adjusted risk for progression and death were not statistically different (hazard ratio (HR) for progression=1.18, 95% confidence interval (CI)=0.87–1.59; P=0.29; 5-year progression-free survival (PFS)=40.9% and 53.8% HR for death=1.04, 95% CI=0.733–1.49; P=0.81; 5-year OS=63.5% and 67.4%, in the SAPL and in the control arm, respectively).Conclusion:SAPL in second-look surgery for advanced ovarian cancer did not improve PFS and OS.

Histological Characteristics and Early-Stage Diagnosis Are Associated With Better Survival in Young Patients With Epithelial Ovarian Cancer: A Retrospective Analysis Based on Surveillance Epidemiology and End Results Database

“…In this patient group, the systemic pelvic and paraaortic lymphadenectomy were not associated with a better OS or progression-free survival (PFS). Similar results were observed in patients with ovarian cancer at early stages (38) and those who underwent lymphadenectomy after primary surgery (39). Due to the limited data on lymph nodes removal such as number, location, postoperative complication, and recurrence rate, we could not get further results.…”

Prognostic value of lymph node ratio in stage IIIC epithelial ovarian cancer with node-positive in a SEER population-based study

“…A meta-analysis indicated that lymphadenectomy can improve the survival of patients with advanced-stage epithelial ovarian cancer (EOC) [ 8 ]. However, the role of lymphadenectomy in EOC is still controversial [ 9 - 11 ]. The lymph node status of EOC patients is currently determined by the number of positive lymph nodes (PLNs), and this is affected by the number of resected lymph nodes (RLNs), and therefore may cause stage migration in some patients.…”

Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies

“…These articles, including 1783 cases and 1705 controls, were published between 1994 and 2013 and consisted of 11 observational studies (16)(17)(18)(19)(20)(23)(24)(25)(27)(28)(29) and three RCTs (21)(22)26). Among the included studies, SL was defined as follows: (i) either pelvic or paraaortic lymphadenectomy or both (16)(17)(19)(20)21,(23)(24)(25)(26)(27)(28)(29); (ii) >20 resected pelvic and para-aortic lymph nodes (18,22).…”