DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20170515

Pelvic lymphadenectomy as a component of interval cytoreduction for ovarian cancer: is there a benefit? A pilot study

D. Suresh Kumar, S. Navin Noushad, M. P. Viswanathan

Abstract


Background: Management strategy in ovarian cancer includes a combination of cytoreductive surgery and chemotherapy. Interval cytoreductive surgery has been shown to be oncologically non-inferior to primary cytoreduction with the additional benefit of reduced morbidity. Lymphadenectomy as a component of cytoreductive surgery has been controversial with an unproven therapeutic benefit.

Methods: Records of patients with a histological diagnosis of ovarian cancer and treated with interval cytoreduction were evaluated. Disease related, pathological and treatment data collected for analysis.

Results: The study included 32 patients with a mean age of 56 years (41-76). Serous papillary tumors (42%) were the predominate histology and the majority were in stage III disease (84%). Optimal cytoreduction was achieved in 93%. The mean nodal harvest was 9.8 nodes with left pelvic dissection yielding slightly more nodes than the right (4.5 vs 5.2). Nodal positivity was observed in just one patient (3%). A total of 314 were nodes examined with only 2 (0.6%) yielding persistent disease. The nodal positivity yield tested as a categorical variable by the binomial test returned P=0.0001.

Conclusions: It is possible to omit pelvic nodal dissection during interval cytoreduction in otherwise optimally cytoreduced patients particularly when imaging and intraoperative assessment are not suggestive of pelvic nodal metastasis.


Keywords


Interval cytoreduction, Ovarian cancer, Pelvic lymphadenectomy

Full Text:

PDF

References


Bereka JS, Crumb C, Friedlanderc M. Cancer of the ovary, fallopian tube, and peritoneum. Intern J Gyne Obst. 2015;131(2):S111-22.

Ganghadaran SGD. Management of Platinum Resistant – Refractory Ovarian Cancer: A Short Review. J Can Rese Treat. 2016;4(2):32-6.

Vergote I, Tropé CG, Amant F, Kristensen GB, Ehlen T, Johnson N, et al. Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med. 2010;363(10):943-53.

Angioli R, Plotti F, Palaia I, Calcagno M. Update on lymphadenectomy in early and advanced ovarian cancer. Curr Opin Obstet Gynecol. 2008;20(1):34-9.

Panici PB, Maggioni A, Hacker N, Landoni F, Ackermann S, Campagnutta E, et al. Systematic aortic and pelvic lymphadenectomy versus resection of bulky nodes only in optimally debulked advanced ovarian cancer: a randomized clinical trial. J Natl Cancer Inst. 2005;97(8):560-6.

Protocol for the Examination of Specimens From Patients With Primary Tumors of the Ovary or Fallopian Tube. Available at: http://www.cap.org/ ShowProperty? nodePath=/ UCMCon/ Contribution%20Folders/ WebContent/ pdf/ cp-ovary-fallopian-16protocol-1000.pdf.

Burghardt E, Pickel H, Lahousen M, Stettner H. Pelvic lymphadenectomy in operative treatment of ovarian cancer. Am J Obstet Gynecol. 1986;155:315-9.

Kigawa J, Minagawa Y, Ishihara H, Kanamori Y, Itamochi H, Terakawa N. Evaluation of cytoreductive surgery with lymphadenectomy including paraaortic nodes for advanced ovarian cancer. Eur J Surg Oncol. 1993;19:273-8.

Spirtos NM, Gross GM, Freddo JL. Cytoreductive surgery in advanced epithelial cancer of the ovary: the impact of aortic and pelvic lymphadenectomy. Obstet Gynecol. 1995;56:345-52.

Scarabelli C, Gallo A, Zarrelli A, Visentin C, Campagnutta E. Systematic pelvic and para-aortic lymphadenectomy during cytoreductive surgery in advanced ovarian cancer: potential benefit on survival. Gynecol Oncol. 1995;56:328-37

Fagotti A, De Iaco P, Fanfani F, Vizzielli G, Perelli F, Pozzati F, et al. Systematic Pelvic and Aortic Lymphadenectomy in Advanced Ovarian Cancer Patients at the Time of Interval Debulking Surgery: A Double-Institution Case–Control Study. Ann Surg Oncol. 2012;19(11):3522-7.

Iwase H, Takada T, Iitsuka C, Nomura H. Clinical significance of systematic retroperitoneal lymphadenectomy during interval debulking surgery in advanced ovarian cancer patients. Gynecol Oncol. 2015;26(4):303-10.

Schwartz L, Schrot-Sanyan S, Brigand C, Baldauf JJ, Wattiez A, Akladios C. Impact of Pelvic and Para-aortic Lymphadenectomy in Advanced Ovarian Cancer After Neoadjuvant Chemotherapy. Anticancer Res. 2015;35(10):5503-9.

Rouzier R, Bergzoll C, Brun JL, Dubernard G, Selle F, Uzan S, et al. The role of lymph node resection in ovarian cancer: analysis of the surveillance, epidemiology, and end results (SEER) database. BJOG. 2010;117:1451-8.