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27 Therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early stage epithelial ovarian cancer
  1. N Bizzarri1,
  2. A Du Bois2,
  3. R Fruscio3,
  4. F De Felice4,
  5. P De Iaco5,
  6. J Casarin6,
  7. E Vizza7,
  8. V Chiantera8,
  9. G Corrado1,
  10. S Cianci1,
  11. P Harter2,
  12. B Ataseven2,
  13. M Bommert2,
  14. AM Perrone5,
  15. S Magni3,
  16. D Ferrari3,
  17. B Zambetti3,
  18. G Scambia1 and
  19. A Fagotti1
  1. 1Fondazione Policlinico Universitario A. Gemelli, IRCCS, UOC Ginecologia Oncologica, Dipartimento per la salute della Donna e del Bambino e della Salute Pubblica, Italy
  2. 2Department of Gynecology and Gynecologic Oncology, Evang. Kliniken Essen-Mitte, Germany
  3. 3Department of Obstetrics and Gynecology, Università degli Studi Milano-Bicocca, San Gerardo Hospital, Italy
  4. 4Department of Radiotherapy, Policlinico Umberto I, ‘Sapienza’ University of Rome, Italy
  5. 5Gynecologic Oncology Unit, S.Orsola-Malpighi Hospital, Italy
  6. 6Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, Italy
  7. 7Gynecologic Oncology Unit, Department of Experimental Clinical Oncology, IRCCS-Regina Elena National Cancer Institute, Italy
  8. 8Department of Gynecologic Oncology, ARNAS Civico, University of Palermo, Italy


Introduction The therapeutic role of pelvic and para-aortic lymphadenectomy in surgical staging of apparent early-stage epithelial ovarian cancer (aeEOC) is still unclear. Recently, ESGO-ESMO consensus established that re-staging lymphadenectomy is not recommended if patients are already due to receive adjuvant chemotherapy for high-risk eEOC. The aim of this study was to evaluate the potential therapeutic role of systematic lymphadenectomy in patients with eEOC.

Methods Multi-center retrospective cohort study with CE approval, comparing women with aeEOC who underwent no lymphadenectomy (NL) versus lymph node sampling (SL) versus adequate systematic bilateral pelvic and para-aortic lymphadenectomy (AL) (defined as ≥20 lymph-nodes).

Inclusion criteria epithelial ovarian carcinoma; no bulky (≥10 mm short axis) pelvic or para-aortic lymph nodes at CT-scan; complete intra-peritoneal staging and at least 3 cycles of platinum-based adjuvant chemotherapy.

Results 639 of 2,559 patients with FIGO stage IA-IIIA1 ovarian cancer, met inclusion criteria. 360 (56.3%) underwent AL, 150 (23.5%) SL and 129 (20.2%) NL (table 1). AL patients were younger (p<0.001), experienced a higher number of grade 3–5 post-operative complications (p=0.008) and had a longer time to start chemotherapy (p=0.034). There was no difference in intra-operative complications. Median follow-up was 63 months (range, 5–342). The 5-year disease-free survival (DFS) was 79.7% vs. 76.5% vs. 68.3% (p=0.006) (figure 1), and 5-year overall survival (OS) was 92.3% vs. 94.5% vs. 89.8% (p=0.165) (figure 2) in women who received AL vs. SL vs. NL, respectively. Lymphadenectomy represented independent factor for DFS improvement, HR 0.52 (95%CI 0.37–0.73) (p<0.001).

Abstract 27 Table 1

Patients’ and surgery characteristics

Abstract 27 Figure 1

Disease-free survival in patients undergoing adequate vs sampling vs no lymphadenectomy

Abstract 27 Figure 2

Overall survival in patients undergoing adequate vs sampling vs no lymphadenectomy

Conclusion Pelvic and para-aortic lymphadenectomy in surgical staging of eEOC improves DFS for the price of increasing post-operative complications and time to chemotherapy but does not affect OS.

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