Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer

Chang, Suk-Joon; Bristow, Robert E.; Ryu, Hee Sug

doi:10.1016/j.ygyno.2012.05.014

Cited by 45 publications

(34 citation statements)

References 23 publications

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“…Retroperitoneal lymph node dissection is considered a standard procedure in ovarian cancer surgery, being associated with better PFS and OS in women with advanced stage if complete cytoreduction is achieved [2,3,4]. During this surgical procedure, there is a damage of the lymphatic efferent vessels, which join the cisterna chyli, leading to postoperative lymphorrea.…”

Section: Discussionmentioning

confidence: 99%

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Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Minig

Patrono

Cárdenas-Rebollo

et al. 2016

Gynecol Obstet Invest

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Objective: To describe the incidence of symptomatic lymphocele (SLC) after an aggressive tumor debulking surgery and lymphadenectomy in patients with ovarian cancer and peritoneal carcinomatosis with or without TachoSil®. Material and Methods: A pilot retrospective comparative observational study was performed between patients with advanced ovarian cancer International Federation of Gynecology and Obstetrics stages III-IV who underwent complete debulking surgery and radical retroperitoneal lymphadenectomy. In 18 patients, 4 TachoSil® patches were placed in the retroperitoneal area, since January 2014-October 2014. This group was compared with other 18 consecutive patients matched by age, International Federation of Gynecology and Obstetrics stage, surgical complexity, American Society of Anesthesiologists score, comorbidity, and BMI without the use of TachoSil®. Results: Baseline characteristics were similar between groups. There were no statistically significant differences in terms of surgical complexity, surgical time, estimated blood loss, node removed, length of hospital stay, and complications between groups. SLC was diagnosed in 7 patients (38.8%) without TachoSil®, and in 2 patients (11.1%) with TachoSil® (p = 0.121). The use of TachoSil® was associated with a statistically significant lower re-admission rate (p = 0.041) and with a significantly shorter time to adjuvant chemotherapy (p = 0.02). Conclusions: Using TachoSil® in women with advanced stage ovarian cancer who underwent radical debulking with retroperitoneal lymph node dissection is associated with a non-statistically significant reduction in the incidence of SLC. A larger-scale randomized controlled study should be conducted to confirm our preliminary results.

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Section: Discussionmentioning

confidence: 99%

“…In these cases, para-aortic and pelvic lymphadenectomy seem to have benefits on progression-free survival (PFS) and overall survival (OS) rates in retrospective studies [2,3,4]. …”

Section: Introductionmentioning

confidence: 99%

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Minig

Patrono

Cárdenas-Rebollo

et al. 2016

Gynecol Obstet Invest

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“…Of the studies, 3 were RCTs and 11 were retrospective studies. Four studies (21,25,27,29) included patients with earlystage ovarian cancer, seven studies (20,22,24,26,28,30,32) included patients with advanced-stage ovarian cancer, and three studies (23,31,33) included both early-and advanced-stage disease. The total numbers of participants ranged from 12 to 2862 in the lymphadenectomy group and from 8 to 3824 in the nonlymphadenectomy group, and overall patient age ranged from 45 to 65 years.…”

Section: Literature Searchmentioning

confidence: 99%

“…Seven studies provided recurrence rate data (21)(22)(23)(27)(28)(29)(30), and were included in the analysis ( …”

Section: Recurrence Ratementioning

confidence: 99%

The effect of lymphadenectomy on survival and recurrence in patients with ovarian cancer: a systematic review and meta-analysis

Zhou

Shan

Chen

2016

Japanese Journal of Clinical Oncology

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Objective: Our objective was to perform a meta-analysis examining the effectiveness of lymphadenectomy in patients with ovarian cancer. Methods: PubMed and CENTRAL databases were searched on 15 November 2015 using the terms 'lymphadenectomy', 'ovarian cancer', 'dissection', 'para-aortic', 'pelvic' and survival. Prospective and retrospective studies comparing the outcomes of surgery with or without lymphadenectomy were included. Outcomes were 5-year overall survival, progression-free survival and recurrence rate. Results: Of the 556 studies identified, 3 randomized controlled trials and 11 retrospective studies were included. Lymphadenectomy was associated with greater 5-year overall survival than no lymphadenectomy (pooled odds ratio = 1.58, 95% confidence interval: 1.41-1.77, p < 0.001). There was no difference in progression-free survival between the groups (pooled overall survival = 1.62, 95% confidence interval: 0.82-3.21, p = 0.168). Lymphadenectomy was associated with greater progression-free survival in randomized clinical trials (pooled overall survival = 1.57, 95% confidence interval: 1.11-2.21, p = 0.010), but not in retrospective studies. Lymphadenectomy was associated with a significantly lower recurrence rate (pooled overall survival = 0.51, 95% confidence interval: 0.30-0.85, p = 0.011). Lymphadenectomy was associated with greater 5-year overall survival in patients with both early and advanced stage cancer, but was associated with greater progression-free survival and lower recurrence rate only in patients with advanced stage cancer. Conclusion: Lymphadenectomy is associated with greater 5-year overall survival in patients with early and advanced stage ovarian cancer, but an effect on progression-free survival and recurrence rate was only found in patients with advanced stage ovarian cancer.

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“…One study reported that the influence of lymph node metastases on prognosis decreases with the increase of residual tumor mass 6,9,24,25. The authors also reported that node metastases seemed to be the second most important prognostic factor for advanced-stage ovarian cancer 6.…”

Section: Discussionmentioning

confidence: 99%

Incidence and Impact of Lymph Node Metastases in Advanced Ovarian Cancer: Implications for Surgical Treatment

Bachmann¹,

Bachmann²,

Fend³

et al. 2016

J. Cancer

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Background: This study aimed to clarify the impact of node involvement (affected to resected nodes) in optimally cytoreduced (residual tumour ≤1cm) stage IIIC/IV ovarian cancer.Methods: 108 consecutive patients with primary stage IIIC/IV ovarian cancer underwent stage-related surgery and got adjuvant platinum-based chemotherapy. Median follow-up: 53.5 months. All patients got systematic para-aortic and pelvic lymphadenectomy. Clinical parameters were retrospectively evaluated. Patients were stratified into 3 groups to evaluate node affection: 1) no (0%), 2) minor (>0%, ≤50%) >0 and 3) major (>50% of affected nodes). Kaplan-Meier survival curve was used to evaluate the prognostic value.Results: On average, 21.3 pelvic and para-aortic nodes were removed per patient (range 1-60 nodes). Minor nodal involvement (node ratio >0-≤0.5: (59%) was most often detected. Increasing node ratio leads to significant decreased overall survival (p<0.001). Significant best overall survival was associated with minor node involvement (node ratio >0 to ≤0.5). Complete cytoreduction correlated with node affection shows significant best prognostic impact in minor node affection compared to incomplete resection (R>0-≤1cm) independent to nodal status (OS p<0.001).Conclusion: Radical surgery is the main factor of improved overall and tumor free survival. Paraaortal and iliacal lymphadenectomy seems to play an important role for prognostic and therapeutic reasons: Prognostic in accurate staging and therapeutic in case of achieved optimal cytoreduction including lymph nodes with histology proven minor node involvement.

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Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer

Cited by 45 publications

References 23 publications

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

Use of TachoSil® to Prevent Symptomatic Lymphocele after an Aggressive Tumor Debulking with Lymphadenectomy for Advanced Stage Ovarian Cancer. A Pilot Study

The effect of lymphadenectomy on survival and recurrence in patients with ovarian cancer: a systematic review and meta-analysis

Incidence and Impact of Lymph Node Metastases in Advanced Ovarian Cancer: Implications for Surgical Treatment

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