Introduction/Background The objective of the current study is to investigate whether systematic pelvic and para-aortic lymphadenectomy offers superior survival rates and fewer peri-operative complications in patients with advanced epithelial ovarian cancer (EOC), tubal, or peritoneal cancer.

Methodology We searched the electronic databases PubMed, Cochrane Central Register of Controlled trials, and Scopus from inception to September 2021. We considered randomised controlled trials (RCTs) comparing systematic pelvic and para-aortic lymphadenectomy with no lymphadenectomy in patients with advanced EOC. Primary outcomes were overall survival and progression-free survival. Secondary outcomes were peri-operative morbidity and operative mortality. The revised Cochrane tool for randomised trials (RoB 2 tool) was utilised for the risk of bias assessment in the included studies. We performed time-to-event and standard pairwise meta-analyses, as appropriate.

Results Two RCTs with a total of 1074 patients were included in our review. Meta-analysis demonstrated similar overall survival (HR = 1.03, 95% CI [0.85 – 1.24]; low certainty) and progression-free survival (HR = 0.92, 95% CI [0.63 – 1.35]; very low certainty). Regarding peri-operative morbidity, systematic lymphadenectomy was associated with higher rates of lymphoedema and lymphocysts formation (RR = 7.31, 95% CI [1.89 – 28.20]; moderate certainty) and need for blood transfusion (RR = 1.17, 95% CI [1.06 – 1.29]; moderate certainty). No statistically significant differences were observed in regard to other peri-operative adverse events between the two arms.

Conclusion Systematic pelvic and para-aortic lymphadenectomy is likely associated with similar overall survival and progression-free survival compared to no lymphadenectomy in optimally debulked patients with advanced EOC. Systematic lymphadenectomy is also associated with an increased risk for certain peri-operative adverse events. Further research needs to be conducted on whether we should abandon systematic lymphadenectomy in completely debulked patients during primary debulking surgery.