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The value of systematic lymphadenectomy during debulking surgery in the treatment of ovarian cancer: a meta-analysis of randomized controlled trials. J Ovarian Res 2020; 13:56. [PMID: 32384898 PMCID: PMC7206784 DOI: 10.1186/s13048-020-00653-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/22/2020] [Indexed: 01/08/2023] Open
Abstract
Background The therapeutic value of systematic lymphadenectomy during debulking surgery for ovarian cancer remains controversial. We conduct this meta-analysis to evaluate the significance of systematic lymphadenectomy in patients treated with optimal cytoreduction for ovarian cancer. Method The PubMed, Medline, Embase, Cochrane Library and Web of Science databases were searched up to October 2019. Only English-language publications of randomized controlled trials (RCTs) that investigated the role of systematic lymphadenectomy in patients with ovarian cancer were selected for this analysis. For overall survival (OS) and progression-free survival (PFS), pooled hazard ratios (HR) with 95% confidence intervals (CIs) were calculated; for complications rate, we calculated pooled risk ratio (RR) with 95% confidence interval (CI). Statistical heterogeneity was assessed using both the I2 and chi-square tests. In cases of I2 being larger than 50%, a random-effect model was used, otherwise a fixed-effect model was used. Results Four RCTs involving 1607 patients were included in the present analysis. There was no difference in OS between systematic lymphadenectomy and unsystematic lymphadenectomy (HR = 1.00; 95% CI = 0.94, 1.07; p = 0.90). Similarly, no significant difference was observed in PFS between these two groups (HR = 0.97; 95% CI = 0.87, 1.08; p = 0.62). And postoperative complications occurred more frequently in the systematic lymphadenectomy group (RR = 1.50; 95% CI = 1.34, 1.68; p < 0.00001). Conclusion Systematic lymphadenectomy in patients with optimally cytoreduced ovarian cancer was not associated with longer overall or progression-free survival than unsystematic lymphadenectomy and was associated with a higher incidence of postoperative complications.
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Lai I, Daniel MN, Rosen BP, May T, Massey C, Feigenberg T. Correlation of differential ascites volume with primary cytoreductive surgery outcome, lymph node involvement, and disease recurrence in advanced ovarian cancer. Int J Gynecol Cancer 2019; 29:ijgc-2019-000310. [PMID: 31113847 DOI: 10.1136/ijgc-2019-000310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 04/04/2019] [Accepted: 04/08/2019] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE High-grade serous ovarian cancer accounts for a disproportionate number of deaths from gynecologic malignancies. It typically presents at an advanced stage and with a high volume of ascites a common presenting feature. The aims of this study is to evaluate the association between ascites volume at the time of primary surgery for advanced stage ovarian cancer with surgical outcomes and patterns of recurrence. METHODS A retrospective review of stage III/IV high-grade serous ovarian cancer patients who underwent primary surgery at two centers between March 2003 to June 2016. Patients were categorized as low-volume ascites (≤ 200 mL) vs high-volume (≥ 1 L). Patients with an unknown volume of ascites or neoadjuvant chemotherapy were excluded. Patients' characteristics were compared for the two groups. Probability of recurrence over time and the HR from a proportional hazards model for sub-distribution were calculated. RESULTS A total of 210 patients were included, 90 (42.9%) patients in the low-volume and 120 (57.1%) patients in the high-volume group. Patients in the low-volume group were older with a median age of 60.2 years vs 56.8 years in the high-volume group and had lower serum CA-125 levels (mean 223 vs 971.5 U/mL). The low-volume group had better surgical outcome with suboptimal debulking (> 1 cm residual disease) in only 17.8 % vs 39.2 % in the high-volume group and had longer median time to recurrence (2.8 years in low-volume vs 1.6 years high-volume group). At the time of recurrence, the low-volume group had a less disseminated pattern of recurrence, lower rates of ascites (20 % in the low-volume group vs 37.2 % in the high-volume group), and a trend toward lower serum CA125 levels (mean 352.8 vs 596.9 U/mL). CONCLUSIONS Advanced stage serous ovarian cancer patients who present with low-volume ascites have lower serum CA125 levels, more optimal cytoreduction rates, and longer disease-free interval. The low-volume group had less ascites, less disseminated disease, and a trend toward lower serum CA125 levels at the time of recurrence.
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Affiliation(s)
- Ingrid Lai
- Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
| | - Maria N Daniel
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Barry P Rosen
- Obstetrics and Gynecology,Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Taymaa May
- Obstetrics and Gynecology,Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
- University Health Network, Toronto, Ontario, Canada
| | - Christine Massey
- Biostatistics, University Health Network, Toronto, Ontario, Canada
- Currently independent statistician, Independent, Brampton, Ontario, Canada
| | - Tomer Feigenberg
- Obstetrics and Gynecology,Division of Gynecologic Oncology, University of Toronto, Toronto, Ontario, Canada
- Obstetrics and Gynecology, Trillium Health Partners, Mississauga, Ontario, Canada
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Gasimli K, Braicu EI, Nassir M, Richter R, Babayeva A, Chekerov R, Darb-Esfahani S, Sehouli J, Muallem MZ. Lymph Node Involvement Pattern and Survival Differences of FIGO IIIC and FIGO IIIA1 Ovarian Cancer Patients After Primary Complete Tumor Debulking Surgery: A 10-Year Retrospective Analysis of the Tumor Bank Ovarian Cancer Network. Ann Surg Oncol 2016; 23:1279-86. [DOI: 10.1245/s10434-015-4959-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Indexed: 11/18/2022]
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Huang S, Dang Y, Li F, Wei W, Ma Y, Qiao S, Wang Q. Biological intensity-modulated radiotherapy plus neoadjuvant chemotherapy for multiple peritoneal metastases of ovarian cancer: A case report. Oncol Lett 2014; 9:1239-1243. [PMID: 25663890 PMCID: PMC4314975 DOI: 10.3892/ol.2014.2820] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 11/26/2014] [Indexed: 11/05/2022] Open
Abstract
The current study presents the case of a 68-year-old female patient who received biological intensity-modulated radiotherapy (BIMRT) and neoadjuvant chemotherapy for multiple peritoneal metastases of ovarian cancer. The International Federation of Gynecology and Obstetrics disease stage was IIIc. In addition, the patient presented with urination and defecation difficulties. The result of tumor marker detection showed a carcinoembryonic antigen level of 348.2ng/ml, a cancer antigen 125 level of 2,091 U/ml and a cancer antigen 19-9 level of 113 U/ml. Computed tomography (CT) indicated and ovarian cystic or solid package, enlargement of multiple abdominal and retroperitoneal lymph nodes and abdominal cavity effusion. Positron emission tomography/CT indicated multiple internal organ metastases. The center of the ovarian cystic or solid package was considered to be a malignant tumor. A large amount of ascites were detected, as well as abdominal and retroperitoneal lymph node metastasis. The patient was treated with BIMRT at a total dose of 48 Gy, administered as a single 4.0-Gy dose 12 times. In addition, 100 mg cisplatin was administered as a peritoneal perfusion, followed by two cycles of 180 mg Taxol and 100 mg cisplatin. Furthermore, the enlargement of the lymph nodes was reduced and the tumor in the region of the ovary had decreased in size by 90%. The ascites had disappeared and the abdominal pain was greatly improved. At the time of writing this manuscript, the patient was well and without relapse. Therefore, modern radiotherapy techniques, such as BIMRT, may be considered as a beneficial treatment option for ovarian cancer patients with multiple peritoneal metastases in whom surgery is not suitable.
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Affiliation(s)
- Shigao Huang
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Yazheng Dang
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Fujun Li
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Wei Wei
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Yuxin Ma
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Song Qiao
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
| | - Qianyun Wang
- Department of Oncology, Chinese People's Liberation Army 323 Hospital, Xi'an, Shaanxi 710054, P.R. China
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5
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Jeong HJ, Kim HJ, Lee EH, Lee HW, Kim MK. Perimenopausal ovarian carcinoma patient with subclavian node metastasis proven by immunohistochemistry. J Menopausal Med 2014; 20:43-6. [PMID: 25371892 PMCID: PMC4217566 DOI: 10.6118/jmm.2014.20.1.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2013] [Revised: 10/22/2013] [Accepted: 11/14/2013] [Indexed: 11/05/2022] Open
Abstract
Ovarian cancer is the seventh most common cancer in the world and the fifth most common cause of death from cancer; it is responsible for over half of all deaths related to gynecological cancers. The presence of lymphatic metastasis is an important prognostic factor in ovarian cancer. Nodal metastases to the pelvic and the para-aortic lymph nodes are common, particularly in an advanced of the disease (stages III-IV). The finding of distant nodal metastasis, especially subclavian lymph node metastasis, from ovarian carcinoma is very uncommon. 18F-fluorodeoxyglucose-positron emission tomography (FDG-PET) or FDG-PET/computed tomography (CT) provides an improved imaging for detecting metastatic lymph nodes in patients with ovarian cancer. Immunohistochemically, ovarian carcinoma cells are positive for estrogen receptor, progesterone receptor, cancer antigen 125, Wilms' tumor 1 protein, and p53; they are negative for thyroid transcription factor (TTF-1) and caudal-related homeobox 2 (CDX-2). This report describes a Korean woman diagnosed with ovarian cancer with subclavian lymph node metastasis revealed by FDG PET/CT and verified by an immunohistochemical staining. Differentiating between the primary ovarian lesion and the metastatic lesion will allow the initiation of an appropriate treatment and help predict the prognosis.
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Affiliation(s)
- Hee Jeong Jeong
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyun Joo Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Eun Hee Lee
- Division of Gynecologic Oncology, Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Hyoun Wook Lee
- Division of Gynecologic Oncology, Department of Pathology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
| | - Min Kyu Kim
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon, Korea
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Ansaloni L, Coccolini F, Catena F, Frigerio L, Bristow RE. Cytoreductive surgery in primary advanced epithelial ovarian cancer. World J Obstet Gynecol 2013; 2:116-123. [DOI: 10.5317/wjog.v2.i4.116] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2012] [Revised: 02/02/2013] [Accepted: 03/07/2013] [Indexed: 02/05/2023] Open
Abstract
Epithelial ovarian cancer is one of the most common malignancy and one of the principal causes of death among gynaecological neoplasm. The majority of patients (about 70%) present with an advanced International Federation of Gynaecology and Obstetrics stage disease. The current standard treatment for these patients consists of complete cytoreduction and combined systemic chemotherapy (CT). An increasing proportion of patients undergoing complete cytoreduction to no gross residual disease (RD) is associated with progressively longer overall survival. As a counterpart, some authors hypothesized the improving in survival could be due more to a less diffused initial disease than to an increase in surgical cytoreduction rate. Moreover the biology of the tumor plays an important role in survival benefit of surgery. It’s still undefined how the intrinsic features of the tumor make intra-abdominal implants easier to remove. Adjuvant and hyperthermic intraperitoneal CT could play a decisive role in the coming years as the completeness of macroscopic disease removal increases with advances in surgical techniques and technology. The introduction of neo-adjuvant CT moreover will play a decisive role in the next years Anyway cytoreduction with no macroscopic residual of disease should always be attempted. However the definition of RD is not universal. A unique and definitive definition is needed.
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7
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Chang SJ, Bristow RE, Ryu HS. Prognostic significance of systematic lymphadenectomy as part of primary debulking surgery in patients with advanced ovarian cancer. Gynecol Oncol 2012; 126:381-6. [DOI: 10.1016/j.ygyno.2012.05.014] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2012] [Revised: 05/08/2012] [Accepted: 05/10/2012] [Indexed: 01/23/2023]
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8
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Yuan Y, Gu ZX, Tao XF, Liu SY. Computer tomography, magnetic resonance imaging, and positron emission tomography or positron emission tomography/computer tomography for detection of metastatic lymph nodes in patients with ovarian cancer: A meta-analysis. Eur J Radiol 2012; 81:1002-6. [DOI: 10.1016/j.ejrad.2011.01.112] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2011] [Accepted: 01/28/2011] [Indexed: 12/22/2022]
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9
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Ramirez I, Chon HS, Apte SM. The Role of Surgery in the Management of Epithelial Ovarian Cancer. Cancer Control 2011; 18:22-30. [DOI: 10.1177/107327481101800104] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Epithelial ovarian cancer is the most deadly gynecologic cancer in the United States. Multiple modalities of therapy are utilized in the management of the disease. The role of surgery remains important in the treatment of this disease and is described herein. Methods Medline and PubMed were utilized to search the English language medical literature up to March 2010. A broad range of studies and quality of data were analyzed, including prospective studies, case control analyses, and meta-analyses. When possible, the highest level of evidence was reviewed and presented. Results For the medically fit patient, optimal cytoreductive surgery positively impacts survival. For some highly selected patients, there is a role for a minimally invasive approach. In the recurrent setting, factors such as interval to recurrence and the distribution of disease will determine the utility of secondary cytoreductive surgery. A subgroup of patients may benefit from palliative surgical procedures in the recurrent setting. Conclusions Despite advances in the use of chemotherapy and biologic agents, surgery remains an important modality in the diagnosis and treatment of ovarian cancer.
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Affiliation(s)
- Ingrid Ramirez
- Department of Obstetrics and Gynecology at the University of South Florida, Tampa, Florida
| | - Hye Sook Chon
- Department of Women's Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
| | - Sachin M. Apte
- Department of Women's Oncology at the H. Lee Moffitt Cancer Center & Research Institute, Tampa, Florida
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10
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Abe A, Furumoto H, Irahara M, Ino H, Kamada M, Naka O, Sasaki M, Kagawa T, Okitsu O, Kushiki N. The impact of systematic para-aortic and pelvic lymphadenectomy on survival in patients with optimally debulked ovarian cancer. J Obstet Gynaecol Res 2010; 36:1023-30. [DOI: 10.1111/j.1447-0756.2010.01274.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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11
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McMahon CJ, Rofsky NM, Pedrosa I. Lymphatic Metastases from Pelvic Tumors: Anatomic Classification, Characterization, and Staging. Radiology 2010; 254:31-46. [DOI: 10.1148/radiol.2541090361] [Citation(s) in RCA: 181] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
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12
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145S4:12S45-9. [PMID: 22793985 DOI: 10.1016/s0021-7697(08)74722-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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13
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Salet-Lizée D, Alsary S. [Not Available]. ACTA ACUST UNITED AC 2008; 145:12S45-9. [PMID: 22794072 DOI: 10.1016/s0021-7697(08)45009-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
D. Salet-Lizée, S. Alsary Ovarian cancer often invades regional lymph nodes but the patterns of involvement are variable; spread to para-aortic and pelvic lymph nodes can be unilateral, contralateral or bilateral. For staging purposes, complete lymph node dissection seems more reasonable and effective than simple lymph node sampling. In early stage disease, lymph node dissection has both diagnostic and therapeutic value allowing identification and optimal management of Stage IIIc tumors with retroperitoneal spread; it may also have direct therapeutic value by removing retroperitoneal micrometastatic disease including cell clones which may be resistant to chemotherapy. Therefore, complete lymph node dissection is recommended in early-stage disease with the exception of stage I mucinous ovarian cancer. In advanced-stage disease, lymph node involvement is an additional factor of poor prognosis correlating with increased tumor aggressivity. Optimal debulking resection of all visible tumor offers the best chance for a prolonged disease-free interval if patient condition permits and morbidity can be limited. Survival benefit for complete lymph node dissection has not been evaluated by randomized controlled trials; but several non-randomized studies and two long-term prospective trials have shown objective improvement in disease-free survival and improved quality of life when debulking surgery leaves no residual tumor larger than 1 cm.
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14
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Prognosis in epithelial ovarian cancer: Clinical analysis of 287 pelvic and para-aortic lymphadenectomy. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s10330-007-0092-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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15
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Ushijima K. Management of retroperitoneal lymph nodes in the treatment of ovarian cancer. Int J Clin Oncol 2007; 12:181-6. [PMID: 17566840 DOI: 10.1007/s10147-007-0672-z] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2007] [Indexed: 10/23/2022]
Abstract
The mechanisms and clinical significance of lymph node involvement in ovarian cancer have been revealed since the International Federation of Gynaecology and Obstetrics (FIGO) introduced a new clinical staging including retroperitoneal lymph node status. The multiple directions of the lymph drainage pathway in ovarian cancer have been recognized. The incidence and pattern of lymph node involvement depends on the extent of disease progression and the histological type. Thus, it is difficult to specify a single node as the sentinel node. As a surgical approach, systemic lymphadenectomy is necessary to obtain accurate clinical stage, and it has obvious diagnostic value. Nevertheless, a recent large randomized trial in patients with advanced ovarian cancer revealed that systemic lymphadenectomy had no impact on survival compared with removing only macroscopic lymph nodes. Other factors, such as chemosensitivity, histological grade, and the size of residuals have also influenced survival in ovarian cancer. From the viewpoint of adverse effects and survival benefit, the efficacy of lymphadenectomy remains controversial. Therefore, further accumulation of clinical data is needed to establish the indications for lymph node dissection; when this procedure is done, it should be performed by experienced gynecologic oncologists at selected institutions.
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Affiliation(s)
- Kimio Ushijima
- Department of Obstetrics and Gynecology, Kurume University School of Medicine, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan.
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Tentes AAK, Mirelis CG, Markakidis SK, Bekiaridou KA, Bougioukas IG, Xanthoulis AI, Tsalkidou EG, Zafiropoulos GH, Nikas IH. Long-term survival in advanced ovarian carcinoma following cytoreductive surgery with standard peritonectomy procedures. Int J Gynecol Cancer 2006; 16:490-5. [PMID: 16681716 DOI: 10.1111/j.1525-1438.2006.00580.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
The impact of cytoreductive surgery with standard peritonectomy procedures has not been extensively assessed in the treatment of advanced ovarian cancer. The aims of the study are to report the long-term results of patients with advanced ovarian cancer undergoing cytoreductive surgery with standard peritonectomy procedures and to identify the prognostic indicators that may affect outcome. The records of 74 women with advanced ovarian cancer were retrospectively reviewed. Clinical indicators were correlated to survival. The hospital mortality and morbidity rates were 13.5% and 28.4%, respectively. Complete or near-complete cytoreduction was possible in 78.4% of the patients. Overall 10-year survival rate was 52.5%. Complete cytoreductive surgery, small-volume tumor, low-grade tumor, the absence of distant metastases, the use of systemic adjuvant chemotherapy, performance status >70%, and limited extent of peritoneal carcinomatosis were favorable indicators of survival. Complete cytoreduction (P= 0.000) and treatment with systemic chemotherapy (P= 0.001) independently influenced survival. Recurrence was recorded in 37.8% of the patients and was independently influenced by the tumor grade (P= 0.037). Cytoreductive surgery with standard peritonectomy procedures followed by adjuvant chemotherapy offers long-term survival in women with advanced ovarian cancer who have limited peritoneal carcinomatosis and no distant and irresectable metastases.
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MESH Headings
- Adenocarcinoma, Clear Cell/drug therapy
- Adenocarcinoma, Clear Cell/mortality
- Adenocarcinoma, Clear Cell/surgery
- Adenocarcinoma, Mucinous/drug therapy
- Adenocarcinoma, Mucinous/mortality
- Adenocarcinoma, Mucinous/surgery
- Adult
- Aged
- Aged, 80 and over
- Carcinoma, Papillary/drug therapy
- Carcinoma, Papillary/mortality
- Carcinoma, Papillary/surgery
- Chemotherapy, Adjuvant
- Cystadenocarcinoma, Serous/drug therapy
- Cystadenocarcinoma, Serous/mortality
- Cystadenocarcinoma, Serous/surgery
- Female
- Hospital Mortality
- Humans
- Lymphatic Metastasis/pathology
- Middle Aged
- Neoplasm Recurrence, Local
- Neoplasm Staging
- Ovarian Neoplasms/drug therapy
- Ovarian Neoplasms/mortality
- Ovarian Neoplasms/surgery
- Peritoneal Neoplasms/drug therapy
- Peritoneal Neoplasms/mortality
- Peritoneal Neoplasms/surgery
- Postoperative Complications/etiology
- Postoperative Complications/mortality
- Prognosis
- Retrospective Studies
- Survival Rate
- Survivors
- Time Factors
- Treatment Outcome
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Affiliation(s)
- A-A K Tentes
- Surgical Department, Didimotichon General Hospital, Didimotichon, Greece.
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Takeshima N, Hirai Y, Umayahara K, Fujiwara K, Takizawa K, Hasumi K. Lymph node metastasis in ovarian cancer: Difference between serous and non-serous primary tumors. Gynecol Oncol 2005; 99:427-31. [PMID: 16112718 DOI: 10.1016/j.ygyno.2005.06.051] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Revised: 06/15/2005] [Accepted: 06/23/2005] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To investigate the lymph node sites most susceptible to involvement relative to primary tumor histology in ovarian cancer. METHODS The locations of metastatic lymph nodes were investigated in 208 patients with primary ovarian cancer who underwent systemic lymphadenectomy covering both the pelvic and para-aortic regions. RESULTS Lymph node metastasis was present in 12.8% (20/156) of patients with stage I (pT1M0), 48.6% (18/37) with stage II (pT2M0), and 60% (9/15) with stage III (pT3M0) disease, thus in 22.6% (47/208) of all study patients. Isolated para-aortic nodal involvement was present in 23.3% (14/60) of patients with serous tumor and 4.1% (6/148) of those with non-serous tumor (P = 0.00002). In an analysis of 35 positive nodes from 25 patients with up to 3 positive nodes, 86.4% (19/22) of metastatic lymph nodes from patients with serous tumor were found in the para-aortic region, with 14 positive nodes located above the inferior mesenteric artery (IMA) and 5 below it, whereas metastasis to para-aortic lymph nodes accounted for 53.8% (7/13) of metastatic lymph nodes from patients with non-serous tumor (P = 0.0334). CONCLUSIONS The locations of metastatic lymph nodes in ovarian cancer depend upon the histologic type of the primary cancer. In cases of serous tumor, the para-aortic region, particularly above the IMA, is the prime site for the earliest lymph node metastasis. However, the likelihood of pelvic node involvement is almost equal to that of para-aortic node involvement in cases of non-serous tumor.
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Affiliation(s)
- Nobuhiro Takeshima
- Department of Gynecology, Cancer Institute Hospital, 3-10-6, Ariake, Koto-ku, Tokyo 135-8550, Japan.
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Münstedt K, Franke FE. Role of primary surgery in advanced ovarian cancer. World J Surg Oncol 2004; 2:32. [PMID: 15461788 PMCID: PMC524187 DOI: 10.1186/1477-7819-2-32] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2004] [Accepted: 10/02/2004] [Indexed: 01/31/2023] Open
Abstract
Background Major issues in surgery for advanced ovarian cancer remain unresolved. Existing treatment guidelines are supported by a few published reports and fewer prospective randomized clinical trials. Methods We reviewed published reports on primary surgical treatment, surgical expertise, inadequate primary surgery/quality assurance, neoadjuvant chemotherapy, interval debulking, and surgical prognostic factors in advanced ovarian cancer to help resolve outstanding issues. Results The aim of primary surgery is a well-planned and complete intervention with optimal staging and surgery. Surgical debulking is worthwhile as there are further effective treatments available to control unresectable residual disease. Patients of gynecologic oncology specialist surgeons have better survival rates. This may reflect a working 'culture' rather than better technical skills. One major problem though, is that despite pleas to restrict surgery to experienced surgeons, specialist centers are often left to cope with the results of inadequate primary surgical resections. Patients with primary chemotherapy or those who have had suboptimal debulking may benefit from interval debulking. A proposal for a better classification of residual tumor is given. Conclusions Optimal surgical interventions have definite role to play in advanced ovarian cancers. Improvements in surgical treatment in the general population will probably improve patients' survival when coupled with improvements in current chemotherapeutic approaches.
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Affiliation(s)
- Karsten Münstedt
- Department of Obstetrics and Gynecology, Justus-Liebig-University of Giessen, Klinikstrasse 32, D 35385 Giessen, Germany
| | - Folker E Franke
- Institute of Pathology, Justus-Liebig-University Giessen, Langhansstrasse 10, D 35385 Giessen, Germany
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Saygili U, Guclu S, Uslu T, Erten O, Ture S, Demir N. Does systematic lymphadenectomy have a benefit on survival of suboptimally debulked patients with stage III ovarian carcinoma? A DEGOG* Study. J Surg Oncol 2002; 81:132-7. [PMID: 12407725 DOI: 10.1002/jso.10124] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND OBJECTIVES The aim of this study was to investigate whether systematic lymphadenectomy is necessary in suboptimally cytoreduced patients with stage III ovarian carcinoma. METHODS Prognostic significance and the effect on survival of systematic pelvic and para-aortic lymphadenectomy were investigated retrospectively in 61 suboptimally debulked patients with stage III ovarian carcinoma. All patients received platinum-based chemotherapy after surgery; 51 patients had been followed for > or =1 year, or until death. Survival curves were calculated according to the Kaplan-Meier method and were evaluated by log-rank test. RESULTS Most patients had stage IIIC disease (60.7%), poorly differentiated tumor (45.9%), and serous histological type (59%). Systematic pelvic and para-aortic lymphadenectomy was performed in 29 patients (47.5%). Lymph node metastases were found in 17 (58.6%) patients; the median number of metastatic nodes was 7 (5-10). Lymph node metastasis was significantly higher in patients with residual disease of >2 cm (P < 0.05). Both univariate and multivariate analyses showed that systematic pelvic and para-aortic lymphadenectomy was not a significant prognostic factor (P > 0.05). In lymph node-dissected patients, survival was significantly longer in patients with minimal residual tumor than in those with residual tumor size >2 cm (P = 0.005). CONCLUSIONS Lymphadenectomy seems not to have an evident prognostic value and a benefit on survival in suboptimally debulked patients with stage III ovarian carcinoma.
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Affiliation(s)
- Ugur Saygili
- Department of Obstetrics and Gynecology, Dokuz Eylul University School of Medicine, Izmir, Turkey.
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Abstract
The exact role of lymphadenectomy in the management of ovarian cancer has been the object of controversy during recent years. The International Federation of Obstetrics and Gynecology has indicated that pelvic and para-aortic lymph node sampling is an integral part of the staging system of ovarian cancer. On the other hand the advantage of systematic sampling, resection of bulky nodes only, or no lymphadenectomy in terms of recurrence rate and survival of ovarian cancer patients has not yet been clearly defined. Thanks to the analysis of clinical studies on systematic lymphadenectomy, detailed anatomical studies to assess the location of lymph nodes and lymphatic spread have been recently reported. In this chapter we report the available data on clinical anatomy and pathological assessment of lymph node and lymphatic spread of ovarian cancer metastasis; we also review the clinical data on correlation of lymph node metastasis and disease status. Surgical techniques developed during years of dedication to this procedure are also described. Finally, we review and discuss the actual benefits of lymph node dissection in patients with ovarian cancer, analysing previously reported and ongoing trials.
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Eisenkop SM, Spirtos NM. The clinical significance of occult macroscopically positive retroperitoneal nodes in patients with epithelial ovarian cancer. Gynecol Oncol 2001; 82:143-9. [PMID: 11426976 DOI: 10.1006/gyno.2001.6232] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The goal of this study was to determine the time during primary cytoreduction when retroperitoneal lymph nodes that are involved with macroscopic disease are recognized to be involved with tumor, the dimensions of intranodal disease present, and the possible clinical significance of macroscopically positive nodes that are recognized at different phases of the operation. METHODS One hundred consecutive patients with stage IIIC and IV epithelial ovarian cancer underwent a retroperitoneal lymph node dissection during primary cytoreductive surgery. The phase of the operation in which nodes were recognized to be macroscopically involved with tumor was noted. Nodes were classified to be positive by palpation if recognized to be macroscopically involved by transperitoneal palpation, positive by inspection if recognized to be macroscopically involved by palpation after opening the retroperitoneal area, and positive by dissection if recognized to be macroscopically involved anytime after starting the actual process of lymph node dissection. The largest dimension of the intranodal disease in macroscopically positive nodes was measured. Log rank analysis determined whether nodal status or the time at which the nodes were recognized to be macroscopically positive influenced the probability of survival. RESULTS Of the 100 patients, 66 had positive lymph nodes. Five were microscopically positive and 61 were macroscopically positive, of which 19 (31.1%) were positive by palpation, 16 (26.2%) were positive by inspection, 26 (42.6%) were positive by dissection. Of the 39 patients with negative and microscopically positive nodes 15 (38.5%) were clinically suspicious. Compared with patients with negative and microscopically positive lymph nodes, survival was not significantly different for patients who required excision of macroscopically positive nodal tissue. Survival was not influenced by the specific phase of surgery in which macroscopically positive nodes were recognized. CONCLUSIONS A significant percentage of patients had retroperitoneal nodes recognized to be involved with macroscopic disease only after a lymph node dissection was in progress. The decision not to perform a lymph node dissection for optimally and completely cytoreduced patients may result in unrecognized macroscopic residual disease that is larger than what would otherwise be documented.
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Affiliation(s)
- S M Eisenkop
- Womens' Cancer Center: Encino-Tarzana, 5525 Etiwanda Avenue, Suite 311, Tarzana, California, 91356, USA
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Abstract
This article aims to cover current concepts and controversies in the surgical management of ovarian cancer. While there have been significant advances in the surgical management of vulval, cervical and even endometrial cancer there have been few developments in the surgical management of ovarian cancer. This situation is likely to continue until we get a clearer understanding of the natural history of this disease and better therapeutic options become available.
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Affiliation(s)
- J F Stratton
- Department of Obstetrics and Gynaecology, Northern General Hospital, Sheffield, UK. john@fstratton
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