Abstract
Objective: The prognostic impact for ovarian cancer treatment of employing a systematic para-aortic and pelvic lymphadenectomy is still poorly defined. The purpose of this study was to evaluate the therapeutic efficacy of adding a para-aortic lymphadenectomy (PA) to the pelvic lymphadenectomy (PL), as compared with solely the pelvic lymphadenectomy. Materials and Methods: A retrospective study of patient outcomes was conducted of ovarian cancer patients who underwent optimal debulking surgery, concurrent with either PA + PL or PL alone, between 2000 and 2009 at our Osaka General Medical Center. Results: One hundred twenty-one patients with ovarian cancer underwent surgery. Forty-four patients (36%) underwent optimal debulking surgery (all residual disease was 1 cm) concurrent with lymphadenectomy. Seventeen patients underwent PA + PL (PA group), and 27 patients underwent PL alone (PL group). There were no significant differences in terms of overall survival (OS; hazard ratio [HR] = 0.49; 95% CI, 0.13 to 1.82; p = 0.29) and progression-free survival (PFS; HR = 0.62; 95% CI, 0.19 to 2.00; p = 0.40) between the PA group and the PL group. Both OS and PFS also failed to show significant differences, even when comparing them among 26 cases of FIGO stage I cases. Conclusions: Our data failed to show any prognostic improvement for ovarian cancer by adding para-aortic lymphadenectomy to the standard pelvic lymphadenectomy regimen.
Highlights
Ovarian cancer has been increasing in Japan
There were no significant differences in terms of overall survival (OS; hazard ratio [HR] = 0.49; 95% CI, 0.13 to 1.82; p = 0.29) and progression-free survival (PFS; HR = 0.62; 95% CI, 0.19 to 2.00; p = 0.40) between the para-aortic lymphadenectomy (PA) group and the pelvic lymphadenectomy (PL) group
There are only a very limited number of studies which have investigated the therapeutic efficacy of adding on a dissection of the para-aortic lymph nodes to the traditional pelvic lymphadenectomy
Summary
Ovarian cancer has been increasing in Japan. 8000 new ovarian cancer cases, and 4500 ovarian cancer deaths, were recorded in 2006 [1]. Retroperitoneal lymph nodes involvement occurs in approximately 50% to 80% of women with advanced ovarian cancer [2]. Cass et al found that 15% of patients with clinical stage I disease have microscopic lymph node metastases [3]. In recognition of the prognostic importance of the retroperitoneal spread of ovarian cancer, the FIGO staging classification was amended in 1988 to include a substage for nodal involvement [4]. Subsequent work has illuminated the relevant surgical anatomy, which has allowed for identification of the role and technical aspects of lymph node dissection, and for a clarification of the nomenclature [5,6,7]
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