Abstract
BackgroundSystematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients. Nevertheless, the corresponding therapeutic may not provide a survival benefit. The aim of this study was to assess the effect of systematic retroperitoneal lymphadenectomy in such patients.MethodsPatients with advanced ovarian cancer (stage III-IV, according to the classification presented by the International Federation of Gynecology and Obstetrics) who were admitted and treated in Zhejiang Cancer Hospital from January 2004 to December 2013 were enrolled and reviewed retrospectively. All patients were optimally or suboptimally debulked (absent or residual tumor < 1 cm) and divided into two groups. Group A (no-lymphadenectomy group, n = 170): patients did not undergo lymph node resection; lymph nodes resection or biopsy were selective. Group B (n = 240): patients underwent systematic retroperitoneal lymphadenectomy.ResultsA total of 410 eligible patients were enrolled in the study. The patients’ median age was 51 years old (range, 28–72 years old). The 5-year overall survival (OS) and 2-year progression-free survival (PFS) rates were 78 and 24% in the no-lymphadenectomy group and 76 and 26% in the lymphadenectomy group (P = 0.385 and 0.214, respectively). Subsequently, there was no significant difference in 5-year OS and 2-year PFS between the two groups stratified to histological types (serous type or non-serous type), the clinical evaluation of negative lymph nodes or with macroscopic peritoneal metastasis beyond pelvic (IIIB-IV). Multivariate Cox regression analysis indicated that systematic retroperitoneal lymphadenectomy was not a significant factor influencing the patients’ survival. Patients in the lymphadenectomy group had a higher incidence of postoperative complications (incidence of infection treated with antibiotics was 21.7% vs. 12.9% [P = 0.027]; incidence of lymph cysts was 20.8% vs. 2.4% [P < 0.001]).ConclusionsOur study showed that systematic retroperitoneal lymphadenectomy did not significantly improve survival of advanced ovarian cancer patients with residual tumor < 1 cm or absent after cytoreductive surgery, and were associated with a higher incidence of postoperative complications.
Highlights
Systematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients
Our study showed that systematic retroperitoneal lymphadenectomy did not significantly improve survival of advanced ovarian cancer patients with residual tumor < 1 cm or absent after cytoreductive surgery, and were associated with a higher incidence of postoperative complications
The majority of patients in Groups A and B were at Federation of Gynecology and Obstetrics (FIGO) stage III (82.4% of Group A and 84.2% of Group B), and a few cases were at stage IV (17.6% of Group A and 15.8% of Group B)
Summary
Systematic retroperitoneal lymphadenectomy has been widely used in the surgical treatment of advanced ovarian cancer patients. Retroperitoneal lymphatic spread has been reported to be a common feature both in early and advanced ovarian cancer patients, the rate of lymph node metastasis is totally about 20–41%, which can reach up to 50–80% in advanced patients (FIGO stage III-IV) [4, 5]. Considering the optimal cytoreduction, comprehensive staging and the guidance of postoperative treatment, the guidelines published by the National Comprehensive Cancer Network (NCCN) recommend that systematic retroperitoneal lymphadenectomy (including pelvic and paraaortic lymphadenectomy) should be included in the primary surgery of early ovarian cancer patients. Studies on whether systematic retroperitoneal lymphadenectomy improve the prognosis of patients with advanced ovarian cancer provide conflicting results. Numerous retrospective studies have shown that retroperitoneal lymphadenectomy can improve prognosis in patients with advanced ovarian cancer [6–10], while some randomized controlled trials did not show survival benefit of systematic retroperitoneal lymphadenectomy in advanced ovarian cancer patients [11, 12]
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