Introduction/Background*Favourable survival outcomes for patients with advanced stage ovarian cancer are associated with complete cytoreduction. In this study, we evaluated the survival impact of cardiophrenic lymph node enlargement in women with advanced stage epithelial ovarian cancer who have undergone cytoreductive surgery.
Methodology The Embase, Medline, Web of science, Cochrane Library and Google scholar databases were searched for articles from the database inception to November 2020. Meta-analysis was conducted to determine the prognostic impact of surgical outcome, postoperative complication and survival using random-effects models.
Result(s)*Fifteen relevant studies, involving 727 patients with CPLN adenopathy and 981 patients without CPLN adenopathy, were included in the review. The prevalence of ascites, and intra and extra abdominal metastases were highest in the CPLN adenopathy group. The mean size of pre-operative CPLN was 9.1± 3.75mm. Eighty-two percent of the patients with CPLN resection, the resected CPLN were histological confirmed pathologic nodes. Surgical outcomes and perioperative complications did not differ between both groups. The pooled median overall survival (OS) was 42.7 months (95% CI 10.8-74.6) versus 47.3 months (95% CI 23.2-71.2) in patients with and without CPLN adenopathy. The pooled median progression free survival (PFS) was 14.6 months (95% CI 4.9-24.4) versus 27.8 months (95% CI 3.2-52.5) respectively. Patients with CPLN adenopathy had a significantly increased risk of disease recurrence (OR4.56, 95% CI 1.98-10.51, P<0.001) and of dying from disease (OR 2.96, 95% CI 2.08- 4.22, p<0.001) compared to those without CPLN adenopathy.
Conclusion*Patients with CPLN adenopathy had a higher tumor burden in both intra and extra-abdominal sites, and lower survival compared to patients without CPLN adenopathy. The available data was not sufficient to definitively confirm a therapeutic role of CPLN resection. A randomized controlled trial is needed to demonstrate the benefit of CPLN resection in cytoreductive surgery.
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