Role of Lymphadenectomy During Interval Debulking Surgery Performed After Neoadjuvant Chemotherapy in Patients With Advanced Ovarian Cancer

Abstract

ObjectiveThe role of lymphadenectomy in interval debulking surgery (IDS) performed after neoadjuvant chemotherapy (NACT) in advanced ovarian cancer remains unclear. We aimed to investigate the clinical significance of lymphadenectomy in IDS.MethodsWe retrospectively reviewed and analyzed the data of patients with advanced ovarian cancer who underwent NACT followed by IDS.ResultsIn 303 patients receiving NACT-IDS, lymphadenectomy was performed in 127 (41.9%) patients. One hundred and sixty-three (53.8%) patients achieved no gross residual disease (NGRD), and 69 (22.8%) had residual disease < 1 cm, whereas 71 (23.4%) had residual disease ≥ 1cm. No significant difference in progression-free survival (PFS) and overall survival (OS) was observed between the lymphadenectomy group and the no lymphadenectomy group in patients with NGRD, residual disease < 1 cm, and residual disease ≥ 1 cm, respectively. The proportions of pelvic, para-aortic and distant lymph node recurrence were 7.9% (10/127), 4.7% (6/127) and 5.5% (7/127) in the lymphadenectomy group, compared with 5.7% (10/176, P = 0.448), 4.5% (8/176, P = 0.942) and 5.1% (9/176, P = 0.878), respectively, in no lymphadenectomy group. Multivariate analysis identified residual disease ≥ 1 cm [hazard ratios (HR), 4.094; P = 0.008] and elevated CA125 levels after 3 cycles of adjuvant chemotherapy (HR, 2.883; P = 0.004) were negative predictors for OS.ConclusionLymphadenectomy may have no therapeutic value in patients with advanced ovarian cancer underwent NACT-IDS. Our findings may help to better the therapeutic strategy for advanced ovarian cancer. More clinical trials are warranted to further clarify the real role of lymphadenectomy in IDS.

Therapeutic Role of Retroperitoneal Lymphadenectomy in 170 Patients With Ovarian Clear Cell Cancer

“…Of the 303 patients included in the study, 163 (53.8%) patients achieved NGR, and 127 (41.9%) patients underwent lymphadenectomy. The results suggested no therapeutic value of lymphadenectomy, with both PFS and OS showing no statistical difference between the lymphadenectomy group and no lymphadenectomy group ( 16 ). In our study, we did not include patients received neoadjuvant chemotherapy for analysis to avoid bias.…”

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

“…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 ].…”

“…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.…”

“…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.…”

“…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.…”