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#682 Role of lymphadenectomy (LND) in advanced ovarian cancer (OC) –a subgroup analysis of the patients excluded from the original lion trial (the charité cohort)
  1. Robert Armbrust1,
  2. Christina Fotopoulou2,
  3. Radoslaw Chekerov1,
  4. Zelal Mustafa Muallem1,
  5. Ionna Braicu1,
  6. Klaus Pietzner1,
  7. Philipp Harter3 and
  8. Jalid Sehouli1
  1. 1Dept. of Gynecology with Center for Oncological Surgery, Charité University Hospital Berlin, Berlin, Germany
  2. 2Imperial College London, London, UK
  3. 3Klinikum Essen Mitte, Essen, Germany


Introduction/Background The results of the prospective randomized phase-III LION-trial failed to demonstrate a therapeutic benefit from LND in tumor-free operated advanced OC patients with macroscopically normal appearing LN. Patients were randomized intraoperatively with exclusion of those thought by the surgeon not to be fully operable or with suspicious/bulky LN by inspection or palpation. We wished to address the surgical and survival outcomes of this excluded group in a single center.

Methodology This is a monocentric analysis in a tertiary ESGO-accredited center of excellence for OC. A total of 202 patients were screened for the original study; 120 were excluded, and 82 included in the final LION analysis. Excluded cases were retrospectively analyzed according to the same endpoints (PFS and OS) of the LION-trial with a subsequent comparison analysis.

Results Overall, 195 patients were included in the present analysis. Rate of CR was with 45% significantly lower in the intraoperatively excluded patients vs the tumor-free operated patients of the original LION analysis. This had a significantly negative impact on OS and PFS. Only 60% of the screening failed patients had histologically positive LN in final pathology. There was no significant difference in PFS or OS between the tumor-free operated screening failed patients versus those randomized, regardless of their histological LN-status and whether an LND was performed.

Conclusion Our findings confirm the lack of therapeutic LND in advanced OC even in patients with suspicious LN. Non-tumor-free operated patients had worse outcome. We demonstrated that intraoperative LN evaluation by the surgeon is subjective and inaccurate.

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