Abstract
Recent robust data allow for omitting lymph node dissection for patients with advanced epithelial ovarian cancer (EOC) and without any suspicion of lymph node metastases, without compromising recurrence-free survival (RFS), nor overall survival (OS), in the setting of primary surgical treatment. Evidence supporting the same postulate for patients undergoing complete cytoreductive surgery after neoadjuvant chemotherapy (NACT) is lacking. Throughout a systematic literature review, the aim of our study was to evaluate the impact of lymph node dissection in patients undergoing surgery for advanced-stage EOC after NACT. A total of 1094 patients, included in six retrospective series, underwent either systematic, selective or no lymph node dissection. Only one study reveals a positive effect of lymphadenectomy on OS, and two on RFS. The four remaining series fail to demonstrate any beneficial effect on survival, neither for RFS nor OS. All of them highlight the higher peri- and post-operative complication rate associated with systematic lymph node dissection. Despite heterogeneity in the design of the studies included, there seems to be a trend showing no improvement on OS for systematic lymph node dissection in node negative patients. A well-conducted prospective trial is mandatory to evaluate this matter.
Highlights
Introduction iationsThe widely accepted aim of the surgical part of the treatment for advanced epithelial ovarian cancer (EOC) is to achieve macroscopic complete resection of peritoneal metastases.The very recent years have shown great improvement in the treatment of advanced EOC, and the main surgical step forward followed the publication of the results of the LION trial late 2018 [1]
We identified six articles that meet our criteria
In Song’s series, among patients with no radiological evidence of lymph node involvement, 25% of micrometastases were still retrieved on pathological examination [8]
Summary
The very recent years have shown great improvement in the treatment of advanced EOC, and the main surgical step forward followed the publication of the results of the LION trial late 2018 [1] This trial demonstrated the non-beneficial effect of lymph node dissection (LND) on overall survival (OS) and recurrence-free survival (RFS) during primary cytoreductive surgery (CRS) for stage IIb-IV EOC in the setting of clinically and radiologically node negative patients. These data emphasize the idea that the burden of peritoneal involvement and the ability to reach a complete macroscopic CRS is the main prognosis factor regardless of lymph node removal.
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