Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients

Abstract

ObjectiveTo investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients.MethodsWe retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses.ResultsFollowing IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized ≥1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS.ConclusionNGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.

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

“…This study also confirmed higher morbidity associated with systematic nodal dissection. 12 A similar result was also reported by Schwartz et al 13 Present study has a few limitations including a small sample size and a lesser nodal yield. Pacini et al defined an adequate pelvic lymphadenectomy as yielding at least 25 nodes but rouzier et al in a SEER data base review of 49,783 patients found a significant difference in survival among nodal groups 0, 1-9 and more than 10 nodes hence our mean nodal yield of 9.8 nodes is unlikely to confound results.…”

The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy

“…In particular, the therapeutic role of systematic lymphadenectomy for advanced EOC remains controversial, and limited data have been reported in IDS cases. Recently, two retrospective studies have reported on the prognostic role of systematic lymphadenectomy in advanced EOC patients at the time of IDS . These studies indicated that systematic lymphadenectomy during IDS had no value with regard to improvements in PFS and OS, and there were high rates of complications, such as long operative time, blood transfusion, and lymphocele occurrence.…”

“…However, one of these studies compared two matched group treated in different institutions, and therefore, each group might have had different treatment policies of surgery and chemotherapy . In addition, the other study included patients who received suboptimal surgery …”

“…In the present study, we observed a significant improvement in OS among patients who underwent pelvic and para-aortic systematic LND 17,18 These studies indicated that systematic lymphadenectomy during IDS had no value with regard to improvements in PFS and OS, time, blood transfusion, and lymphocele occurrence. However, one of these studies compared two matched group treated in different institutions, and therefore, each group might have had different treatment policies of surgery and chemotherapy.…”

“…However, no consensus is present on the clinical role of systematic LND at the time of IDS. Moreover, there have been only two reports on the efficacy of LND during IDS . As a result, there is a lot of confusion on whether to perform LND during IDS, specifically when there is no evidence of nodal metastasis in preoperative evaluation.…”