title: Systematic lymphadenectomy for survival in epithelial ovarian cancer: a meta-analysis.
abstract: BACKGROUND
  The role of systematic lymphadenectomy (SL) remains unclear for improving overall survival (OS) in epithelial ovarian cancer (EOC). To evaluate the role of SL in EOC, we performed a meta-analysis for comparing the efficacy for OS between SL and unsystematic lymphadenectomy (USL).
  
  
  METHODS
  After the extensive literature search between January 1995 and December 2008, we analyzed 9 studies (2 randomized controlled trials [RCTs] and 7 observational studies) with 21,919 patients with EOC who underwent staging laparotomy including SL or USL.
  
  
  RESULTS
  Although SL was a favorable factor for OS compared with USL (hazard ratio [HR], 0.72; 95% confidence interval [CI], 0.68-0.76), the efficacy of SL on increased OS could not be determined in all-stage and early-stage EOC owing to the lack of RCTs and the deviation of weight by large-scale observational studies, whereas SL improved OS in advanced-stage EOC (HR, 0.70; 95% CI, 0.67-0.75). Moreover, SL increased OS in patients with all-stage disease who underwent optimal debulking surgery (HR, 0.84; 95% CI, 0.69-0.99), whereas it could not improve OS statistically in early-stage and advanced-stage diseases. However, SL showed increased OS with marginal significance in advanced-stage EOC patients treated with optimal debulking surgery (HR, 0.82; 95% CI, 0.66-1.02).
  
  
  CONCLUSIONS
  These findings suggest the possibility that SL can improve OS in advanced-stage EOC. However, the efficacy of SL on OS is still unknown because of the lack of RCTs, which requires more relevant studies for investigating the role of SL in EOC.
authors.affiliation: Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hee Seung
authors.initials: HS
authors.lastname: Kim
authors.forename: Woong
authors.initials: W
authors.lastname: Ju
authors.forename: Byung Chul
authors.initials: BC
authors.lastname: Jee
authors.forename: Yong Beom
authors.initials: YB
authors.lastname: Kim
authors.forename: Noh Hyun
authors.initials: NH
authors.lastname: Park
authors.forename: Yong Sang
authors.initials: YS
authors.lastname: Song
authors.forename: Seung Cheol
authors.initials: SC
authors.lastname: Kim
authors.forename: Soon-Beom
authors.initials: SB
authors.lastname: Kang
authors.forename: Jae Weon
authors.initials: JW
authors.lastname: Kim
mesh_terms: D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D009367:Neoplasm Staging; D009375:Neoplasms, Glandular and Epithelial / Q000401:mortality* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000401:mortality* / Q000601:surgery; D011379:Prognosis; D016032:Randomized Controlled Trials as Topic; D015996:Survival Rate; D016896:Treatment Outcome