# Evaluating the Impact of Retroperitoneal Lymphadenectomy in Terms of Morbidity and Survival in Advanced Epithelial Ovarian Cancer

## TL;DR

This study examines the safety and effectiveness of a specific surgical procedure in advanced ovarian cancer patients, finding it is generally safe and provides useful staging information.

## Contribution

The study provides updated evidence on morbidity and survival outcomes associated with retroperitoneal lymphadenectomy in advanced ovarian cancer.

## Key findings

- RPLND had a high nodal positivity rate (59.39%) and manageable complications like lymphatic leaks and vascular injuries.
- Five-year overall survival was 48.9%, with median disease-free survival of 32.3 months.
- RPLND aided in accurate staging and optimal cytoreduction without procedure-related mortality.

## Abstract

Background

This study aims to assess the role of routine systematic retroperitoneal lymphadenectomy (RPLND) in managing advanced ovarian cancer while maintaining acceptable levels of morbidity and without mortality associated with the procedure. However, concerns have emerged regarding its insufficiency in delivering survival benefits.

Method

A retrospective analysis of prospectively maintained electronic records from 2012 to 2023 was conducted at our tertiary referral center among 362 cases of advanced ovarian cancer. Patients with International Federation of Gynecology and Obstetrics (FIGO) stages III and IV cancer underwent optimal cytoreductive surgery (CRS) with standard upfront and interval procedures, including systematic RPLND, and selected cases underwent hyperthermic intraperitoneal chemotherapy (HIPEC). We analyzed RPLND-associated morbidity, encompassing both intraoperative and postoperative complications.

Result

The mean age of the patients was 55.2 years. The lymph nodes were found to be positive in 215 patients (59.39%), and the positivity rate was higher in those who underwent upfront surgery (n=139; 64.65%), as compared to those who received neoadjuvant chemotherapy (NACT; n=76; 35.35%). RPLND-related post-operative complications were vascular: inferior vena cava (IVC) injury (n=10; 2.76%), aortic injury (n=6; 1.6%), and lymphatic leaks in the postoperative period (n=21; 5.80%) patients. Out of these 21 patients, some developed lymphatic ascites (n=13; 3.59%), chylous ascites (n=8; 2.4%), and postoperative ileus (n=12; 3.32%). Recurrence was reported 104 patients (39.69%) during the follow-up period. For a median follow-up of 58.5 months, the median disease-free survival (DFS) was 32.3 months. The overall five-year survival in our patients was 48.9% (95% CI 35.5-61).

Conclusion

RPLND in advanced ovarian cancer was feasible, revealed high nodal positivity (>50%), and was associated with manageable morbidity without mortality. It facilitates precise disease staging and helps achieve optimal cytoreduction.