Risks and benefits of systematic lymphadenectomy during interval debulking surgery for advanced high grade serous ovarian cancer

Benoit, Louise; Koual, Meriem; Frère‐Belda, Marie‐Aude Le; Zerbib, J.; Fournier, Laure; Nguyen-Xuan, Huyên-Thu; Delanoy, Nicolas; Bentivegna, Enrica; Bats, Anne‐Sophie; Azaïs, Henri

doi:10.1016/j.ejso.2021.10.027

Cited by 6 publications

(15 citation statements)

References 24 publications

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“…No additional eligible studies were retrieved by hand-searching bibliographies. Nine fulfilled the inclusion criteria for this systematic review, involving a total of 1,660 patients [ 32 33 34 35 36 37 38 39 40 ].…”

Section: Resultsmentioning

confidence: 99%

“…The characteristics of included studies are detailed in Table 1 . All nine studies were retrospective [ 32 33 34 35 36 37 38 39 40 ]. No randomized controlled trials were found.…”

Section: Resultsmentioning

confidence: 99%

“…No randomized controlled trials were found. Six studies (66.7%) [ 33 35 36 38 39 40 ] were monocentric and 3 (33.3%) [ 32 34 37 ] were multicentric. The studies were published between 2012 and 2021, while the period of patient enrollment varied from 1996 and 2018 across the series.…”

Section: Resultsmentioning

confidence: 99%

“…Depending on the series, patients underwent different patterns of nodal surgery procedures: 1) systematic pelvic and para-aortic LN dissection (SyLND); 2) resection of bulky nodes or radiologically suspicious lymph nodes (SeLND); 3) no lymph node dissection (NoLND). Five studies compared SyLND to NoLND [ 33 34 37 38 40 ], three studies compared SyLND to SeLND [ 32 35 39 ], and one compared the 3 groups [ 36 ]. Of the 1,660 patients included, 827 (49.8%) underwent SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND.…”

Section: Resultsmentioning

confidence: 99%

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Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

et al. 2022

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Objective To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC). Methods Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay. Results Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65–1.20; p=0.43) and 0.80 (95% CI=0.50–1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19–2.82; p=0.006), 3.38 (95% CI=1.71–6.70; p<0.001), 7.23 (95% CI=3.40–15.36; p<0.0001), and 1.22 (95% CI=0.50–2.96; p=0.67). Conclusion Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications. Trial Registration PROSPERO Identifier: CRD42022303577

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Section: Resultsmentioning

confidence: 99%

“…The characteristics of included studies are detailed in Table 1 . All nine studies were retrospective [ 32 33 34 35 36 37 38 39 40 ]. No randomized controlled trials were found.…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

et al. 2022

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“…R0 cytoreduction always involves more radical surgical procedures, including peritoneum stripping, bowel resection, splenectomy, and liver resections. The debilitated state of older patients leads to severe postoperative morbidities [ 18 , 27 ] and consequently leads to delay or discontinuation of adjuvant chemotherapy, which may negate the benefit of R0 cytoreduction. A more recent study indicated that increased 90-day morbidity leads to a lower 3-year survival [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

Zhao

Zuo

et al. 2022

Cancers

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Background: The prognosis of older patients with ovarian cancer is poor. We evaluated the effect of chronological age and different treatment characteristics on the prognosis of older patients with ovarian cancer; Methods: The study retrospectively analyzed patients aged over 60 years who underwent cytoreduction followed by platinum-based adjuvant chemotherapy between January 2011 and December 2019 in two national centers in China. Propensity score matching (PSM, 1:1) was performed to stratify the comorbidity- and treatment-related factors. The Kaplan–Meier method was employed to estimate progression-free survival (PFS) in the original cohort and the cohort after PSM; Results: A total of 324 patients were evaluated. The Age ≥ 70 group often received more neoadjuvant chemotherapy (62.3% vs. 31.2%, p < 0.001), more discontinuation of adjuvant chemotherapy (31.2% vs. 10.8%, p < 0.001), and had more severe chemotherapy-related toxicity (45.6% vs. 34.2%, p = 0.040) than the Age < 70 group. After matching, the PFS of the Age < 70 group was not significantly different from the Age ≥ 70 group (median PFS = 12.4 and 11.9 months, respectively, p = 0.850). Furthermore, the advanced FIGO stage, non-R0 cytoreduction, and discontinuation of adjuvant chemotherapy were all found to be poor prognostic factors. Serum albumin level <40 g/L (HR = 2.441, p = 0.018) and age ≥ 70 years (HR = 2.639, p = 0.008) led to more severe chemotherapy-related toxicity. Additionally, poor renal function (HR = 5.128, p = 0.002) was in association with discontinuation of adjuvant chemotherapy; Conclusions: The chronological age of older patients cannot be seen as a poor prognostic factor. Older patients may benefit most from R0 cytoreduction followed by the completion of chemotherapy. Postoperative poor renal function and serum albumin level <40 g/L may help predict the discontinuation of adjuvant chemotherapy.

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Prognostic Value of Lymph Node Parameters in Elderly Patients With Stage III Serous Ovarian Cancer Based on Competing Risk Model

Sun

Peng

Chen

et al. 2023

American Journal of Clinical Oncology

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Objectives: Competing risk models were used in this study. The purpose of this study was to assess the predictive usefulness of lymph node characteristics in elderly patients with stage III serous ovarian cancer. Methods: We conducted a retrospective analysis on 148,598 patients from 2010 to 2016 using the surveillance, epidemiology, and end results database. Lymph node characteristics were collected and examined, including the number of lymph nodes retrieved the number of lymph nodes examined (ELN) and the number of positive lymph nodes (PN). Using competing risk models, we evaluated the connection between these variables and overall survival (OS) and disease-specific survival (DSS). Results: This study included a total of 3457 ovarian cancer patients. Multivariate analysis using the COX proportional hazards model found that ELN>22 was an independent predictive factor for both OS (hazard ratio [HR] [95% CI]=0.688 [0.553 to 0.856], P<0.05) and DSS (HR [95% CI]=0.65 [0.512 to 0.826], P<0.001), PN>8 was identified as a significant risk factor for both OS (HR [95% CI]=0.908 [0.688 to 1.199], P=0.497) and DSS (HR [95% CI]=0.926 [0.684 to 1.254], P=0.62). Subsequently, using the competing risk model, ELN>22 was found to be an independent protective factor for DSS (HR [95% CI]=0.738 [0.574 to 0.949], P=0.018), while PN>8 was identified as a risk factor for DSS (HR [95% CI]=0.999 [0.731 to 1.366], P=1). Conclusions: Our findings demonstrate the robustness of the competing risk model to evaluate the results of the COX proportional hazards model analysis.

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Risks and benefits of systematic lymphadenectomy during interval debulking surgery for advanced high grade serous ovarian cancer

Cited by 6 publications

References 24 publications

Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis

Differences in Treatment Modalities and Prognosis of Elderly Patients with Ovarian Cancer: A Two-Center Propensity Score-Matched Study

Prognostic Value of Lymph Node Parameters in Elderly Patients With Stage III Serous Ovarian Cancer Based on Competing Risk Model

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