Clinical impact of systematic pelvic and para-aortic lymphadenectomy for pT1 and pT2 ovarian cancer: a retrospective survey by the Sankai Gynecology Study Group.
BACKGROUND
The therapeutic value of systematic lymphadenectomy for early-stage epithelial ovarian cancer (EOC) is controversial. This study evaluates the survival impact and adverse events of systematic pelvic and para-aortic lymphadenectomy in patients with pT1 and pT2 EOC.


METHODS
A retrospective investigation was performed using data from patients with pT1 and pT2 EOC at multi-institutions belonging to the Sankai Gynecologic Study Group (SGSG). We selected patients who had undergone systematic pelvic and para-aortic lymphadenectomy (Group LA) (n = 284) and patients who had not undergone lymph node resection (Group no-LA) (n = 138). Outcomes for patients and peri-operative adverse events were compared between the two groups.


RESULTS
The median operation time was significantly longer in Group LA (288 min) than in Group no-LA (128 min) (P < 0.0001). Total blood loss was significantly higher in Group LA, 43.7 % of patients receiving blood transfusions. There were no significant differences between the treatment groups for progression-free survival (PFS) or overall survival (OS). However, for patients with pT2, PFS was significantly longer in Group LA than in Group no-LA (P = 0.0150). Lymph node metastases were detected in 23 cases (8.1 %) and these patients had significantly shorter PFS than those without metastasis (P = 0.0409). The outcome for patients who underwent chemotherapy after surgery was significantly improved in the Group no-LA, but no improvement was observed in Group LA.


CONCLUSIONS
Systematic lymphadenectomy may improve outcomes only in pT2 EOC patients with acceptable peri-operative events. Furthermore, accurate surgical staging may avoid unnecessary adjuvant chemotherapy in selected early-stage cases.
Department of Obstetrics and Gynecology, Miyoshi Central Hospital, 531 Higashisakeyamachi, Miyoshi, Hiroshima, 728-8502, Japan, toshita@hicat.ne.jp.
Takafumi
T
Oshita
Hiroaki
H
Itamochi
Ryuichiro
R
Nishimura
Fumitaka
F
Numa
Kazuhiro
K
Takehara
Masamichi
M
Hiura
Hirotoshi
H
Tanimoto
Jun
J
Noma
Ryoji
R
Hayase
Akihiro
A
Murakami
Hideo
H
Fujimoto
Yasunobu
Y
Kanamori
Fuminori
F
Kitada
Keiji
K
Shitsukawa
Makoto
M
Nagaji
Yukihisa
Y
Minagawa
Michihisa
M
Fujiwara
Junzo
J
Kigawa
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008197:Lymph Node Excision / Q000009:adverse effects*; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery*; D010388:Pelvis / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult