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. 2015 Oct;26(4):303-10.
doi: 10.3802/jgo.2015.26.4.303. Epub 2015 Jul 17.

Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients

Haruko Iwase  1 , Toshio Takada  2 , Chiaki Iitsuka  2 , Hidetaka Nomura  2 , Akiko Abe  2 , Tomoko Taniguchi  2 , Ken Takizawa  2
Affiliations

Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients

Haruko Iwase et al. J Gynecol Oncol. 2015 Oct.

Abstract

Objective: To investigate the clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery (IDS) in advanced epithelial ovarian cancer (EOC) patients.

Methods: We retrospectively reviewed the medical records of 124 advanced EOC patients and analyzed the details of neoadjuvant chemotherapy (NACT), IDS, postoperative treatment, and prognoses.

Results: Following IDS, 98 patients had no gross residual disease (NGRD), 15 had residual disease sized <1 cm (optimal), and 11 had residual disease sized ≥1 cm (suboptimal). Two-year overall survival (OS) and progression-free survival (PFS) rates were 88.8% and 39.8% in the NGRD group, 40.0% and 13.3% in the optimal group (p<0.001 vs. NGRD for both), and 36.3% and 0% in the suboptimal group, respectively. Five-year OS and 2-year PFS rates were 62% and 56.1% in the lymph node-negative (LN-) group and 26.2% and 24.5% in the lymph node-positive (LN+) group (p=0.0033 and p=0.0024 vs. LN-, respectively). Furthermore, survival in the LN+ group, despite surgical removal of positive nodes, was the same as that in the unknown LN status group, in which lymphadenectomy was not performed (p=0.616 and p=0.895, respectively). Multivariate analysis identified gross residual tumor during IDS (hazard ratio, 3.68; 95% confidence interval, 1.31 to 10.33 vs. NGRD) as the only independent predictor of poor OS.

Conclusion: NGRD after IDS improved prognosis in advanced EOC patients treated with NACT-IDS. However, while systematic retroperitoneal lymphadenectomy during IDS may predict outcome, it does not confer therapeutic benefits.

Keywords: Cytoreduction Surgical Procedures; Disease-Free Survival; Lymph Node Excision; Neoadjuvant Therapy; Neoplasm, Residual; Ovarian Neoplasms.

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Conflict of interest statement

CONFLICT OF INTEREST: No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. Survival according to residual disease. (A) Overall survival. (B) Progression-free survival. NGRD, no gross residual disease.
Fig. 2
Fig. 2. Survival according to lymph node metastasis. (A) Overall survival. (B) Progression-free survival. Exp, exploratory laparotomy; LN-, lymph node-negative; LN+, lymph node-positive; U-LN, unknown lymph node.
See this image and copyright information in PMC

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