Abstract
Background: The effect of systematic lymphadenectomy (SL) on survival in patients with optimally debulked advanced ovarian cancer remains unclear. We evaluated the therapeutic value of SL in advanced ovarian cancer patients who underwent primary optimal debulking surgery.Methods: A meta-analysis was carried out using articles retrieved from the PubMed, Embase, and Cochrane databases. Overall survival (OS) and progression-free survival (PFS) were compared between patients who underwent SL and those who underwent unsystematic lymphadenectomy (USL).Results: Seven studies that included 2,425 patients with advanced ovarian cancer were included in the meta-analysis. The overall analyses indicated significantly improved OS [hazard ratio (HR) = 0.64, 95% confidence interval (CI): 0.49–0.84, P < 0.01] but not PFS (HR = 0.89, 95% CI: 0.69–1.15, P = 0.38) in patients who underwent SL compared to those who underwent USL. Subgroup analyses based on study type, study quality, total numbers of patients, and International Federation of Gynecology and Obstetrics (FIGO) stage provided similar results. However, subgroup analysis of patients with no residual tumor revealed that SL was not associated with improved OS (HR = 0.81, 95% CI: 0.66–1.00, P = 0.05) or PFS (HR = 1.09, 95% CI: 0.91–1.30, P = 0.33).Conclusions: In patients with optimally debulked advanced ovarian cancer, SL may improve OS but not PFS. However, SL does not provide a survival advantage when macroscopically complete resection of all visible tumors is achieved.
Highlights
Ovarian cancer is the second most common cancer [1]
Primary debulking surgery with the goal of macroscopically complete resection of all visible tumors followed by platinum/taxane-based chemotherapy is the primary treatment for advanced ovarian cancer [3]
Seven studies with a total of 2,425 patients (SL group = 1,378, unsystematic lymphadenectomy (USL) group = 1,047) who met the inclusion criteria were included in the analysis [9, 12,13,14, 25,26,27]
Summary
Ovarian cancer is the second most common cancer [1]. In 2018, there were 295,414 new cases of ovarian cancer and 184,799 deaths due to ovarian cancer worldwide [2]. Some studies have reported that complete and optimal debulking surgery can improve survival outcomes [5, 6]. Lymphatic spread is commonly observed in both early and advanced ovarian cancer [7], and retroperitoneal lymph node metastasis has been reported to be related to a poor prognosis [8]. It is unclear whether systematic lymphadenectomy (SL) can improve survival outcomes, especially in patients with optimally debulked advanced ovarian cancer [9]. The effect of systematic lymphadenectomy (SL) on survival in patients with optimally debulked advanced ovarian cancer remains unclear. We evaluated the therapeutic value of SL in advanced ovarian cancer patients who underwent primary optimal debulking surgery
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