Lymphadenectomy in surgical stage I epithelial ovarian cancer

Abstract

Objective: To identify the extent of lymphadenectomy performed in women presenting with epithelial ovarian cancer macroscopically confined to the ovary. Furthermore, the effect of lymphadenectomy on overall survival is evaluated.

Design: A prospective nationwide case-only study.

Setting: Denmark 2005-2011.

Sample: All women registered in the nationwide Danish Gynecologic Cancer Database from 1 January 2005 to 1 May 2011, presenting with a tumor macroscopically confined to the ovary without visible evidence of abdominal spread at the time of the initial exploration (surgical stage I).

Method: Descriptive and survival analyses of data from Danish Gynecologic Cancer Database.

Main outcome measures: The annual proportion of women with surgical stage I disease who received lymphadenectomy and the survival in the two groups.

Results: Of 2361 women with epithelial ovarian cancer, 627 were identified with surgical stage I. Lymphadenectomy was performed in 216 women (34%) of whom 13 (6%) had lymph node metastases. At 5-year follow up 85% remained alive in the lymphadenectomy group compared with 80% in the control group (p = 0.064). The lymphadenectomy fraction increased from 24% in 2005 to 55% in 2011. When univariate and multivariate analyses were conducted only an insignificant difference in the survival probability was found between lymphadenectomy and no lymphadenectomy in women presenting with tumor macroscopically confined to the ovary.

Conclusion: Although increasing, the number of women with surgical stage I disease in Denmark who receive lymphadenectomy remains low, but this did not seem to make a difference to survival.

Keywords: Ovarian epithelial cancer; lymph node dissection; lymph node metastases; lymphadenectomy; surgical staging.