Systematic pelvic and aortic lymphadenectomy in advanced ovarian cancer patients at the time of interval debulking surgery: a double-institution case-control study.
BACKGROUND
The prognostic role of systematic lymphadenectomy remains unclear in advanced ovarian cancer (AOC). Only few retrospective case series have investigated the percentage of lymph node metastases after neoadjuvant chemotherapy. This multi-institutional case-control study analyzed the prognostic role of systematic lymphadenectomy in AOC patients at the time of interval debulking surgery (IDS).


METHODS
From January 2005 to December 2010, the records of patients with AOC admitted to IDS at the Catholic University of Rome (n = 101, controls) and at the University of Bologna (n = 50, cases) were retrospectively analyzed. The cases, routinely submitted to systematic pelvic and aortic lymphadenectomy, were matched 1:2 with the controls, who did not routinely undergo lymphadenectomy. To correctly assess the prognostic role of lymphadenectomy, only patients with optimally debulked disease were included. Progression-free survival and overall survival were analyzed by a log-rank test.


RESULTS
After an overall mean follow-up of 36 months (95% confidence interval 33-39), 35 and 63 recurrences (70.0 vs. 62.4%; p = NS) and 15 and 24 deaths due to disease (30 vs. 23.7%; p = NS) were observed in the case and controls, respectively. The 2-year progression-free survival rate was 36 versus 25% (p = 0.834), and the 2-year overall survival rate was 69 versus 88% (p = 0.777), in the case and controls, respectively. The median operating time was longer, and the percentage of patients requiring blood transfusions was higher in the cases than in the controls (225 vs. 210 min, p = 0.023, and 54 vs. 22.8%, p = 0.0001, respectively).


CONCLUSIONS
Lymphadenectomy at the time of IDS could be omitted, at least in high-risk patients.
Gynecologic Oncology Unit, Catholic University of the Sacred Heart, Rome, Italy. annafagotti@libero.it
Anna
A
Fagotti
Pierandrea
P
De Iaco
Francesco
F
Fanfani
Giuseppe
G
Vizzielli
Federica
F
Perelli
Federica
F
Pozzati
Anna Myriam
AM
Perrone
Luigi Carlo
LC
Turco
Giovanni
G
Scambia
D000328:Adult; D000368:Aged; D001011:Aorta; D001803:Blood Transfusion; D016022:Case-Control Studies; D017024:Chemotherapy, Adjuvant; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis*; D061646:Operative Time; D010051:Ovarian Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery*; D010388:Pelvis; D012189:Retrospective Studies