Does lymphadenectomy effect postoperative surgical morbidity and survival in patients with adult granulosa cell tumor of ovary?

Abstract

Aim To evaluate the effect of lymphadenectomy on surgical morbidity and survival in adult granulosa cell tumor (AGCT) of the ovary. Methods Patients who underwent surgical treatment for AGCT between January 1993 and January 2016 were identified. Data were collected for patient age, menopausal status, surgical staging, lymphadenectomy, postoperative complications (anemia, wound infection, incisional hernia), length of hospital stay, follow‐up duration, site and time for recurrence, management of recurrence and vital status. Histopathological records were also evaluated for number of cellular mitosis. Results Lymphadenectomy (pelvic–paraaortic) was performed in 53 (53%) of 98 patients. Decrease in postoperative hemoglobin level and increased wound infection and longer hospital stay were significantly higher in lymphadenectomy group (P = 0.003, 0.043 and <0.001, respectively). Tumor stage (HR 95% CI 14.9 [2.43–92.8]) and number of mitoses >5 (HR 95% CI 14.9 [2.43–92.8]) were significantly associated with recurrence (P = <0.001 and 0.02, respectively). Tumor stage was the only prognostic factor for predicting overall survival (HR 95% CI 8.47 [2.17–33.2]). Lymphadenectomy showed no effect on disease‐free survival and overall survival both in multivariate Cox regression analyses (P = 0.46 and 0.69, respectively). Disease‐free survival and overall survival were similar in lymphadenectomy and no lymphadenectomy groups (Log Rank P = 0.382, 0.741, respectively). Conclusion Lymphadenectomy had no improved effect on survival and had negative effect on surgical morbidity in patients with AGCT.

Impact of Lymphadenectomy on Outcomes of Early-Stage Ovarian Cancer: A Systematic Review and Meta-Analysis

“…After reviewing them by the titles and abstracts, we excluded 3,504 studies due to nonrelevance with the review topic. Of the 38 studies selected for full-text analysis, 24 were excluded with reasons and a total of 12 studies were included in the review (30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41). Details of included studies are presented in Table 1.…”

“…Only one study was an RCT while all others were retrospective observational studies. Six studies ( 30 , 31 , 33 , 34 , 36 , 41 ) were conducted on epithelial tumors, three on malignant germ-cell tumors ( 32 , 39 , 40 ), two on sex cord-stromal tumors ( 35 , 38 ) and one was only on ovarian carcinosarcoma ( 37 ). The sample size in the lymphadenectomy arm varied from 40 to 8,489 patients while in the control arm it varied from 22 to 4,628 patients.…”

"Coffe Bean" Nucleic in a Rare Case of Ovarian Adult Granulosa Cell Tumor

“…In over 70% of cases the recurrences were identified at the pelvic level, 9% at the abdominopelvic level, 6% retroperitoneally, 6% were cases with both pelvic and retroperitoneal recurrences and only 3% were represented by simultaneous recurrences in the retroperitoneum and abdominopelvic cavity [3].…”

Molecular Pathways and Targeted Therapies for Malignant Ovarian Germ Cell Tumors and Sex Cord–Stromal Tumors: A Contemporary Review

“…Routine lymphadenectomy is controversial and depends on the tumor subtype and pre-and intra-operative findings [15,23,24]. Patients with adult granulosa cell tumors in particular have low rates of lymph node metastases and do not seem to benefit from lymphadenectomy [25][26][27][28]. In addition to obtaining diagnostic and prognostic information, surgery is a major component of therapy.…”