The efficacy of systematic lymph node dissection in advanced epithelial ovarian cancer during interval debulking surgery performed after neoadjuvant chemotherapy

Abstract

Systematic LND may have therapeutic value in advanced EOC patients treated with NAC and IDS.

Impact of Lymphadenectomy on Survival of Patients with Serous Advanced Ovarian Cancer After Neoadjuvant Chemotherapy: A French National Multicenter Study (FRANCOGYN)

“…They showed improvement in OS with a median survival of 28 months for LNS vs. 37 months for LND, with HR = 0.29 (0.15–0.57) p = < 0.001. The same was true with PFS, with HR = 0.637 (0.429–0.946), p = 0.025 [ 28 ]. Concerning PFS, SL had positive impact.…”

“…This is the only study evaluating the impact of SL in IDS in patients with advanced serous ovarian adenocarcinoma after NAC. Other studies evaluated the impact of SL in patients with ovarian adenocarcinoma of all histological subtypes after NAC [ 26 , 27 , 28 , 29 , 30 , 31 ]. Our results are consistent with those published [ 26 , 27 , 29 , 30 , 31 ] that did not demonstrate improvement in OS for SL after NAC.…”

“…Eoh et al demonstrated improvement in overall survival [ 28 ]. The major difference between our study and that of Eoh et al [ 28 ] was that they compared two groups: lymph-node sampling (LNS) (<20 resected node) and lymph-node dissection (LND) (min 20 resected nodes), and not SL versus no lymphadenectomy. They showed improvement in OS with a median survival of 28 months for LNS vs. 37 months for LND, with HR = 0.29 (0.15–0.57) p = < 0.001.…”

Metastasis to para-aortic lymph nodes cephalad to the renal veins in patients with ovarian cancer

“…In this study, extended PAN dissection was not compared directly with conventional PAN dissection. However, the frequency of complications (including pulmonary complications, infection, intestinal complications, thromboembolism, lymphatic complications, and blood transfusion) was similar to or lower than the rates of perioperative complications reported after conventional PAN dissection [8,[11][12][13], suggesting that the safety of extended PAN dissection was not inferior to conventional dissection and that dissecting the supra-renal PANs has little negative impact.…”

“…When PDS was performed in patients with T3 cancer, the incidence rate of infra-renal PAN metastasis was reported to be 52-84.7% [6][7][8][9]. In addition, the incidence rate of infra-renal PAN metastasis was reported to be 47.0-78.5% in patients undergoing IDS, suggesting that PAN metastases were still frequent even after NAC [10][11][12]. In the present study, infrarenal PAN metastasis was observed in 1 out of 14 patients with T1 and T2 cancer (7.1%) versus 8 out of 11 patients with T3 cancer (72.7%).…”