The Role of Systematic Lymphadenectomy in Low-Grade Serous Ovarian Cancer: A Systematic Review and Meta-Analysis

Author:

Montero-Macías Rosa1ORCID,Segura-Sampedro Juan José234ORCID,Rigolet Pascal5,Lecuru Fabrice67,Craus-Miguel Andrea48,Castillo-Tuñón Juan Manuel9ORCID

Affiliation:

1. Department of Gynecology and Obstetrics, Hospital Center of Poissy Saint Germain en Laye, 78300 Poissy, France

2. Section of Peritoneal, Retroperitoneal and Soft Tissue Oncological Surgery, General & Digestive Surgery Service, La Paz University Hospital, IdiPAZ, 28046 Madrid, Spain

3. School of Medicine, University of the Balearic Island, 07122 Palma de Mallorca, Spain

4. Health Research Institute of the Balearic Islands (IdISBa), 07009 Palma de Mallorca, Spain

5. Curie Institute, Paris-Saclay University, CNRS UMR 9187, Inserm U1196, CEDEX F-91898, 91400 Orsay, France

6. Breast, Gynecology and Reconstructive Surgery Unit, Curie Institute, 75005 Paris, France

7. School of Medicine, Paris Cité University, 75006 Paris, France

8. General and Digestive Surgery Department, Son Espases University Hospital, 07009 Palma de Mallorca, Spain

9. HPB and Oncological Surgery Department, Virgen Macarena University Hospital, 41009 Seville, Spain

Abstract

Objective: To evaluate the role of systematic lymphadenectomy in low-grade serous ovarian cancer (LGSOC) and determine its impact on clinical outcomes in overall survival (OS) and disease-free survival (DFS) terms. Methods: A comprehensive, systematic computer literature search on PubMed was performed using the following Medical Subject Headings (MeSH) terms: “low grade serous ovarian cancer” AND/OR “lymphadenectomy” AND/OR “staging” AND/OR “ovarian cancer” AND/OR “cytoreduction”. Separate searches were performed with MeSH terms on MEDLINE and EMBASE to extract all the relevant literature available. We included only patients with histologically confirmed LGSOC. Results: Three studies were considered in the quantitative analysis. Systematic lymphadenectomy in LGSOC failed to provide a significant OS or PFS benefit in LGSOC when compared to no lymphadenectomy in the entire (all the stages) population (for OS: HR = 1.15, 95% CI [0.42, 3.18] I2 = 84% and for PFS: HR = 1.46, 95% CI [0.63, 3.41], I2 = 71%), nor did it in the subtype analysis regarding FIGO stages. For FIGO early-stage I-II LGSOC, the DFS data were pooled (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%). In patients with advanced-stage (FIGO II–IV), we also failed to prove survival benefit for lymphadenectomy in OS (HR = 1.74, 95% CI [0.87, 3.48], I2 = 11%) or DFS (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%) compared to no lymphadenectomy. Conclusion: More extensive prospective research is mandatory to understand the real impact of lymphadenectomy on survival in LGSOC. The existing literature does not provide strong evidence.

Publisher

MDPI AG

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