The Role of Lymphadenectomy in Node-Positive Epithelial Ovarian Cancer

Pereira, Augusto MD, PhD*†; Pérez-Medina, Tirso MD; Magrina, Javier F. MD*; Magtibay, Paul M. MD*; Millan, Isabel MS; Iglesias, Enrique PhD

International Journal of Gynecological Cancer:
doi: 10.1097/IGC.0b013e318257b958
Ovarian Cancer
Abstract

Objective: To evaluate the therapeutic role of pelvic and aortic lymphadenectomy in patients with epithelial ovarian cancer (EOC) and positive nodes (stages IIIC and IV).

Methods: Retrospective chart review. Data from all consecutive patients with EOC and positive retroperitoneal lymph nodes (stage IIIC and IV) in Mayo Clinic from 1996 to 2000 were included. To evaluate the impact of nodal metastases, the extent of lymphadenectomy was compared according to the number of nodes removed and positive nodes resected. Multivariable Cox regression and Kaplan-Meier survival curves were used for analysis.

Results: The median number of nodes removed was 31 (pelvic, 21.5, and aortic, 10), and the median number of positive nodes was 5. The 5-year overall survival was 44.8%. On multivariate analysis, only the extent of peritoneal metastases before surgery was a significant factor for survival (P = 0.001 for stage IIIC and P = 0.004 for stage IV). Analysis of 83 patients with advanced peritoneal disease more than 2 cm demonstrated before debulking, removal of more than 40 lymph nodes was a significant prognostic factor for overall survival (hazard ratio, 0.52; P = 0.032; 95% confidence interval, 0.29–0.35). In 29 patients with advanced peritoneal disease and no residual disease after debulking, removal of more than 10 positive was a factor for survival.

Conclusions: There was a survival benefit in patients with EOC with advanced peritoneal disease more than 2 cm before debulking when more than 40 lymph nodes were removed. There was an additional survival benefit in those patients with no residual disease after debulking when more than 10 positive nodes were removed.

Author Information

*Division of Gynecologic Surgery Mayo Clinic, Phoenix, AZ; †Department of Gynecologic Surgery, and ‡Statistics Department, Puerta de Hierro University Hospital, Madrid, Spain.

Address correspondence and reprint requests to Augusto Pereira, MD, PhD, Department of Gynecologic Surgery, Puerta de Hierro University Hospital, Joaquin Rodrigo 2, Madrid, 28222 Spain. E-mail: apereiras@sego.es.

The authors declare that there are no conflicts of interest.

Received January 31, 2012

Accepted March 28, 2012

Copyright © 2012 by IGCS and ESGO