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

Abstract

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.

Quality Indicators and Survival Outcome in Stage IIIB-IVB Epithelial Ovarian Cancer Treated at a Single Institution

“…The value of performing a full lymphadenectomy in advanced ovarian cancer is a subject of debate. It has been proposed earlier that systematic pelvic and paraaortic lymphadenectomy could facilitate cytoreduction (9), favor 5year overall-and progression-free survival in randomized clinical trials, and reduce recurrence rate (18). However, a study by Harter et al did not confirm the association of systematic pelvic and paraaortic lymphadenectomy with longer overall or progression-free survival, but has suggested that it contributes to a higher incidence of postoperative complications (19).…”

Standard primary cytoreduction surgery (CRS) procedure for ovarian cancer (FIGO Stage IIB-IV)

“…It is meaningful to have a radical tumor resection in the abdominal cavity, if the patient is in good physical condition, age 75 years old, and the tumor is invasive epithelial carcinoma. Lymphadenectomy is associated with greater 5-year overall survival in early and advanced stages of ovarian cancer, also have shown the effect on progression-free survival and recurrence rate in patients with advanced stage ovarian cancer 24 .…”

SEOM Clinical Guideline in ovarian cancer (2016)

“…Lymphadenectomy is recommended in the early stage OC in non-mucinous histological subtypes, as it allows complete staging that provides prognostic information and is associated with greater OS [8] [II, A].…”