The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer

• Published in: The journal of obstetrics and gynaecology research Vol. 36; no. 5; pp. 1023 - 1030
• Main Authors: Abe, Akiko, Furumoto, Hiroyuki, Irahara, Minoru, Ino, Hiroyasu, Kamada, Masaharu, Naka, Osamu, Sasaki, Masaru, Kagawa, Toshiaki, Okitsu, Osamu, Kushiki, Norio
• Format: Journal Article
• Language: English
• Published: Melbourne, Australia Blackwell Publishing Asia 01.10.2010
• Subjects: Adult; Carcinoma - mortality; Carcinoma - surgery; Female; Humans; Kaplan-Meier Estimate; Lymph Node Excision - methods; lymphadenectomy; ovarian cancer; Ovarian Neoplasms - mortality; Ovarian Neoplasms - surgery; Regression Analysis; Retroperitoneal Space - surgery; Survival Rate; Treatment Outcome
• ISSN: 1341-8076; 1447-0756
• DOI: 10.1111/j.1447-0756.2010.01274.x

Aim:  The objective of this study was to verify the impact of systematic retroperitoneal lymphadenectomy on survival in patients with ovarian cancer. Material & Methods:  During 2001–2005, clinical records of 118 patients with epithelial ovarian cancer were collected in Tokushima prefecture. From a number of hospitals, patients in one group were treated without systematic lymphadenectomy, and in another group, patients were treated with routine systematic lymphadenectomy. Clinical records were reviewed retrospectively and progression‐free survival (PFS) and overall survival (OS) were compared. Results:  Sixty‐two patients were staged as I–II according to the macroscopic findings at surgery. Forty of these patients received systematic lymphadenectomy and 22 patients did not. The 5‐year OS was 100 and 80%, respectively (P = 0.07). The 5‐year PFS was 94 and 71%, respectively (P = 0.04). In patients with clear cell adenocarcinoma, 3‐year OS and PFS were significantly better in the lymphadenectomy group (P = 0.01, P = 0.046, respectively). The 56 patients staged as III–IV according to the macroscopic findings at surgery were optimally debulked. Twenty‐eight of these patients received systematic lymphadenectomy and 28 patients did not. There is no difference in the 5‐year OS (65 and 66%, respectively; P = 0.71) or the 5‐year PFS (30 and 52%, respectively; P = 0.48). Conclusion:  This study has demonstrated that the systematic lymphadenectomy had benefit only in patients with ovarian cancer macroscopically confined to the pelvis. In patients with clear cell adenocarcinoma, systematic lymphadenectomy was beneficial. To the contrary, systematic lymphadenectomy had no benefit on OS or PFS in patients with advanced ovarian cancer if optimally debulked.