Impact of systematic lymphadenectomy at the time of interval debulking surgery on the survival of patients with advanced-stage epithelial ovarian carcinoma following neoadjuvant chemotherapy

Abstract

<h3>Objectives:</h3> In light of evidence from the LION trial, we aimed to evaluate the impact of systematic lymphadenectomy (LN) at the time of interval debulking surgery (IDS) for patients with advanced stage epithelial ovarian carcinoma. <h3>Methods:</h3> Patients with stage III-IV epithelial ovarian carcinoma without a history of another tumor who underwent neoadjuvant chemotherapy and underwent interval debulking with complete gross resection (CGR) were identified in the National Cancer Database (2010-2015). Based on pathology report patients who did not undergo any lymphadenectomy and those who underwent systematic lymphadenectomy (defined as at least 20 lymph nodes removed) were selected for further analysis. Median overall survival was compared with the log-rank test and a Cox multivariate model was constructed to control for confounders. <h3>Results:</h3> A total of 1060 patients who met the inclusion criteria were identified. Median patient age was 64 years while the majority had serous tumors (95.8%) and did not have co-morbidities (79.2%). Systematic LND was performed for 125 (11.8%) patients with a median of 29 LNs (range 20-72) removed. Rate of positive LNs was 62.4%, while median number of positive LN was 5 (range 1-28). Patients who underwent systematic LND had higher rate of unplanned readmission (8.9% vs 1.6%, p<0.001), and median hospital stay (6 vs 4 days, p<0.001). Median OS for patients who did not undergo LND was 40.38 months compared to 44.19 for those who underwent systematic LND, p=0.40. After controlling for patient age, insurance status, race, presence of comorbidities, tumor histology, and disease stage, performance of systematic LND was not associated with better survival (HR: 0.98, 95% CI: 0.80, 1.19). Lastly, median overall survival of patients with positive LNs (n=78) was 40.05 months. <h3>Conclusions:</h3> Systematic lymphadenectomy is rarely performed at the time of interval debulking surgery and was not associated with a survival benefit.