Is there any therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer?

Nicolò Bizzarri, Andreas du Bois, Robert Fruscio, Francesca De Felice, Pierandrea De Iaco, Jvan Casarin, Enrico Vizza, Vito Chiantera, Giacomo Corrado, Stefano Cianci, Sonia Magni, Debora Ferrari, Daniela Giuliani, Philipp Harter, Beyhan Ataseven, Mareike Bommert, Anna Myriam Perrone, Giovanni Scambia, Anna Fagotti

Research output: Contribution to journalArticlepeer-review

Abstract

Objective: The therapeutic role of pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer (eEOC) is still under debate. The aim of this study was to evaluate the potential therapeutic role of systematic lymphadenectomy in patients with eEOC. Methods: Multi-center retrospective cohort study, comparing women with apparent eEOC who underwent comprehensive bilateral pelvic and para-aortic lymphadenectomy (defined as ≥20 lymph nodes) versus patients receiving no lymphadenectomy or lymph node sampling, from 05/1985 to 12/2016. Patients with bulky nodes at CT-scan and those without complete intra-peritoneal surgical staging were excluded. Only patients who received at least 3 cycles of platinum-based adjuvant chemotherapy were included. Results: Out of 2559 patients with FIGO stage IA-IIIA1 ovarian cancer, 639 (25.0%) met inclusion criteria. 360 (56.3%) underwent comprehensive lymphadenectomy, 150 (23.5%) lymph node sampling and 129 (20.2%) no lymphadenectomy. Patients who underwent comprehensive lymphadenectomy were younger (p < 0.001), experienced a higher number of severe post-operative complications (p = 0.008) and had a longer time to start chemotherapy (p = 0.034). There was no difference in intra-operative complications. Median follow-up was 63 months (range, 5–342). The 5-year disease-free survival (DFS) was 79.7% vs. 76.5% vs. 68.3% (p = 0.006), and 5-year overall survival (OS) was 92.3% vs. 94.5% vs. 89.8% (p = 0.165) in women who received comprehensive lymphadenectomy vs. lymph node sampling vs. no lymphadenectomy, respectively. Lymphadenectomy represented an independent factor for DFS improvement, HR 0.52 (95%CI 0.37–0.73) (p < 0.001). Conclusion: Pelvic and para-aortic lymphadenectomy in surgical staging of eEOC improves DFS for the price of increasing post-operative complications and time to chemotherapy but does not affect OS. Better understanding of tumor biology may help to identify those patients in whom lymphadenectomy should still play a role.

Original languageEnglish
Pages (from-to)56-63
Number of pages8
JournalGynecologic Oncology
Volume160
Issue number1
DOIs
Publication statusPublished - Jan 2021

Keywords

  • Early-stage
  • Lymph node sampling
  • Lymphadenectomy
  • Ovarian cancer
  • Prognosis
  • Surgical staging

ASJC Scopus subject areas

  • Oncology
  • Obstetrics and Gynaecology

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