Lymphadenectomy in ovarian cancer does not prolong survival

Systematic lymphadenectomy of aortic and pelvic lymph nodes during surgery for advanced ovarian cancer improves progression-free survival, but does not prolong the woman’s life, according to results of a prospective, multicenter study.

The therapeutic value of systematic lymphadenectomy in these patients is controversial, Dr. Roldano Fossati and colleagues note in their paper, published in the Journal of the National Cancer Institute for April 20. While small, retrospective studies have suggested a survival benefit, there have been no large, prospective studies.Dr. Fossati, at Istituto Mario Negri in Milan, Italy, and colleagues at 13 sites in five countries randomly assigned 216 patients with FIGO stage IIIB-C and IV epithelial ovarian carcinoma to undergo systematic pelvic and para-aortic lymphadenectomy and 211 to resection of bulky nodes only. Both groups underwent maximal cytoreductive surgery followed by adjuvant treatment with platinum-based chemotherapy.After a median follow-up of 68.4 months, 5-year progression-free survival rates were 31.2% in the lymphadenectomy arm and 21.6% in the no-lymphadenectomy arm. Corresponding median progression-free survival times were 27.4 months and 22.4 months.However, median 5-year overall survival was 49.5% when systematic lymphadenectomy was performed and 48.0% when it was not, which the authors note was not a significant difference.Dr. Fossati’s group found that systematic lymphadenectomy was associated with a higher incidence of postoperative complications — though most were mild — and greater blood loss, but there were no differences in length of hospital stay between groups. On the other hand, they say, longer progression-free survival, by avoiding chemotherapy during that time, “may have an important impact on quality of life of patients with advanced ovarian cancer.”Dr. Setsuko K. Chambers, at the Arizona Cancer Center in Tucson, Arizona, lauds this study, calling it “pivotal” and suggesting that “it will discourage the routine use of (systematic lymphadenectomy) and hence its attendant toxicity.”(Source: J Natl Cancer Inst 2005;97:548-549,560-566: Reuters Health: Oncolink: May 2005.)