The role of Lymphadenectomy in early-stage mucinous Ovarian Cancer

TL;DR

This study finds that lymphadenectomy in early-stage mucinous ovarian cancer does not improve survival and increases surgical complications.

Contribution

The study provides evidence against routine lymphadenectomy for early-stage mucinous ovarian cancer due to low metastasis risk and increased morbidity.

Findings

Lymph node metastasis was not detected in any patients with early-stage mucinous ovarian cancer.

Lymphadenectomy increased operation time and hospital stay without improving survival rates.

Five-year disease-free and overall survival rates were similar between groups with and without lymphadenectomy.

Abstract

To assess the effect of lymphadenectomy on morbidity and survival in patients with early-stage mucinous ovarian cancer.

Patients with clinical stage-I primary mucinous ovarian cancer who underwent surgery in the gynecological oncology clinic of Tepecik Education and Research Hospital, Izmir, Turkey between January 1998 to December 2018 were analyzed retrospectively. The patients were divided into two groups according to whether lymphadenectomy (pelvic ± para-aortic) was performed or not. The groups were compared in terms of clinical variables.

Forty-five patients were examined. Lymphadenectomy was performed in 30 (66.7%) patients. Metastasis was not detected in any of the lymph nodes. There was no significant difference between the groups in terms of age, menopausal status, stage, tumor grade, bilaterality, ascites, tumor size and preoperative cancer antigen 125, carbohydrate antigen 19-9, carcinoembryonic antigen. Patients who underwent lymphadenectomy had longer durations of operation time and hospital stay (p<0.001 and p=0.011, respectively). The median follow-up time was 96 (3-240) months. Recurrence developed in two (4.4%) patients. The five-year disease-free survival rates of the groups with and without lymphadenectomy were 96.4% and 92.9%, respectively (p=0.666). The five-year overall survival rates of the groups with and without lymphadenectomy were calculated as 96.4% and 92.9%, respectively (p=0.666).

The risk of lymph node metastasis is very low in early-stage mucinous ovarian cancer. Lymphadenectomy causes an increase in the duration of operation and hospital stay and does not contribute to disease-free and overall survival. Therefore, routine lymphadenectomy should be carefully evaluated in clinical early-stage mucinous ovarian cancer to reduce morbidity.

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