Lymph nodes dissection in advanced ovarian cancer
Keywords:ovarian cancer, systematic lymphadenectomy, primary cytoreduction, para-aortic lymph nodes, pelvic lymph nodes
Ovarian cancer becomes the most aggressive disease among all cancer pathology in women’s reproductive system. Surgery and chemotherapy are the main options on the way of ovarian cancer treatment. Cytoreductive surgeries are the main way of surgical treatment of patients with advanced ovarian cancer. The goal of this kind of surgeries is resections of all macroscopic implants.
The opportunity of systematic lymph nodes dissection from renal vessels to obturator nerve is the reason of scientific discussion. LION trial (Lymphadenectomy In Ovarian Neoplasms) showed no significant difference in overall survival in two groups of patients with advanced ovarian cancer with IIВ–IV stages, who performed systematic lymphadenectomy and who did not. Authors showed higher level of postoperative complications in group with systematic lymph node dissections. But it was analyzed only those patients, who had intraoperative clinically insignificant lymph nodes. However, if the lymph nodes are macroscopically changed, performing a lymphadenectomy is advisable in order to achieve complete cytoreduction.
Purpose of the study: assessment of lymph nodes dissection in patients with advanced ovarian cancer.
Materials and methods. Retrospective analysis of patients with primary ovarian cancer IIIC–IV stages with clinically significant lymph nodes, which were subjected to interval or primary cytoreduction with systematic lymphodissection from the level of renal vessels to the obturator pit.
Results. Complete and optimal cytoreduction was achieved in patients with systemic para-aortic and pelvic lymphodissection from the level of renal vessels to the obturator pit, which was not accompanied by postoperative complications and fatality.
Conclusion. The study results demonstrates the possibility of safe systemic lymphodissection, which contributes to the achievement of complete or optimal cytoreduction, and improves the rates of disease-free survival.
Fedorenko, Z., Goulak, L., Gorokh, Y., et al. “Cancer in Ukraine: incidence, mortality, activities of the oncological service.” (2020). Available from: [http://www.ncru. inf.ua/publications/].
Bray, F., Ferlay, J., Soerjomataram, I., et al. “Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries.” Cancer J Clin 68.6 (2018): 394–424.
Colombo, N., Sessa, C., du Bois, A., et al. “ESMO–ESGO consensus conference recommendations on ovarian cancer: pathology and molecular biology, early and advanced stages, borderline tumours and recurrent disease.” Int J Gynecol Cancer 29.4 (2019): 1–33. DOI: 10.1136/ijgc-2019-000308
Ang, C,. Chan, K.K., Bryant, A., et al. “Ultra-radical (extensive) surgery versus standard surgery for the primary cytoreduction of advanced epithelial ovarian cancer.” Cochrane Database Syst Rev 13 (2011): CD007697.
Thrall, M.M., Goff, B.A., Symons, R.G., et al. “Thirty-day mortality after primary cytoreductive surgery for advanced ovarian cancer in the elderly.” Obstet Gynecol 118 (2011): 537–47.
Zhou, J., Zhang, W.W., Zhang, Q.H., et al. “The effect of lymphadenectomy in advanced ovarian cancer according to residual tumor status: A population-based study.” Int J Surg 52 (2018): 11–5. DOI: 10.1016/j.ijsu.2018.02.006
Song, N., Gao, Y., et al. “Therapeutic value of selective lymphadenectomy in interval debulking surgery for stage IIIc and IV epithelial ovarian cancer.” Int J Gynecol Cancer 29.4 (2019): 761–7. DOI: 10.1136/ijgc-2018-000200
Gmyrek, L., Jońska-Gmyrek, J., Żółciak-Siwińska, A., et al. “Therapeutic value of lymphadenectomy in ovarian cancer patients.” Ginekol Pol 85.10 (2014): 788–91.
Gao, J., Yang, X., Zhang, Y., et al. “Systematic lymphadenectomy in the treatment of epithelial ovarian cancer: a meta-analysis of multiple epidemiology studies.” Jpn J Clin Oncol 45.1 (2015): 49–60. DOI: 10.1093/jjco/hyu175
Matsuo, K., Machida, H., Mariani, A., et al. “Adequate pelvic lymphadenectomy and survival of women with early-stage epithelial ovarian cancer.” J Gynecol Oncol 29.5 (2018): e69. DOI: 10.3802/jgo.2018.29.e69
Paño, B., Sebastià, C., Ripoll, E., et al. “Pathways of lymphatic spread in gynecologic malignancies.” RadioGraphics 35.3 (2015): 916–45. DOI: 10.1148/rg.2015140086
NCCN Clinical practice guidelines in oncology (NCCN Guidelines®). Ovarian cancer fallopian tube cancer and primary peritoneal cancer. Version 3.2019.
Kehoe, S., Hook, J., Nankivell, M., et al. “Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial.” Lancet Oncol 386 (2015): 249–57.
Vergote, I., Coens, C., Nankivell, M. “Neoadjuvant chemotherapy versus debulking surgery in advanced tubo-ovarian cancers: pooled analysis of individual patient data from the EORTC 55971 and CHORUS trials.” Lancet Oncol 19.12 (2018): 1680–7. DOI: 10.1016/S1470-2045(18)30566-7
Maggioni, A., et al. “Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis.” Br J Cancer 95/6 (2006): 699–704.
Harter, P., Gnauert, K., Hils, R., et al. “Pattern and clinical predictors of lymph node metastases in epithelial ovarian cancer.” Int J Gynecol Cancer 17.6 (2007): 1238–44.
Fournier, M., Stoeckle, E., Guyon, F., et al. “Lymph node involvement in epithelial ovarian cancer: sites and risk factors in a series of 355 patients.” Int J Gynecol Cancer 19.8 (2009): 1307–13.
Morice, P., Joulie, F., Camatte, S., et al. “Lymph node involvement in epithelial ovarian cancer: analysis of 276 pelvic and paraaortic lymphadenectomies and surgical implications.” Am Coll Surg 197 (2003): 198–205.
Panici, P.B., Maggioni, A., Hacker, N., 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 CancerInst 97.8 (2005): 560–6. DOI: 10.1093/jnci/dji102
Chan, J.K., Urban, R., Hu, J.M., et al. “The potential therapeutic role of lymphnoderesection in epithelial ovarian cancer: a study of 13 918 patients.” Br J Cancer 96 (2007): 1817–22.
du Bois, A., Reuss, A., Harter, P., et al. “Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials.” J Clin Oncol 28 (2010): 1733–9. DOI: 10.1200/JCO.2009.25.3617
Harter, P., Sehouli, J., Lorusso, D., et al. “LION – Lymphadenectomy In Ovarian Neoplasms. A Prospective Randomized Ago Study Group Led Gynecologic Cancer Intergroup Trial.” Presented at ASCO Annual Meeting (2017).
Fagotti, A., Ferrandina, G., Vizzielli, G., et al. “Phase III randomised clinical trial comparing primary surgery versus neoadjuvant chemotherapy in advanced epithelial ovarian cancer with high tumour load (SCORPION trial): Final analysis of peri-operative outcome.” Eur J Cancer 59 (2016): 22–33. DOI: 10.1016/j.ejca.2016.01.017
du Bois, A., Reuss, A., Harter, P., et al. “Potential role of lymphadenectomy in advanced ovarian cancer: a combined exploratory analysis of three prospectively randomized phase III multicenter trials.” Oncol 28 (2010): 1733–9.
Greimel, E., Kristensen, G.B., van der Burg, M.E., et al. “Quality of life of advanced ovarian cancer patients in the randomized phase III study comparing primary debulking surgery versus neo-adjuvant chemotherapy.” Gynecol Oncol 131.2 (2013): 437–44. DOI: 10.1016/j.ygyno.2013.08.014
Ercelep, O., Ozcelik, M., Gumus, M. “Association of lymphadenectomy and survival in epithelial ovarian cancer.” Curr Probl Cancer 43.2 (2019): 151–9. DOI: 10.1016/j.currproblcancer.2018.08.002
Copyright (c) 2020 V. S. Svintsitskiy, N. P. Tsip, S. V. Nespryadko, V. I. Kopetskyi, M. Y. Yegorov, O. M. Movchan, O. P. Renkas, O. I. Bubliieva
This work is licensed under a Creative Commons Attribution 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution License that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgement of its initial publication in this journal.