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Incidence of lymph node metastasis in early-stage low-grade serous ovarian cancer: a systematic review
  1. David Viveros-Carreño1,2,
  2. Juliana Rodriguez1,3 and
  3. Rene Pareja1,4
  1. 1Department of Gynecologic Oncology, Instituto Nacional de Cancerología, Bogotá, Colombia
  2. 2Gynecologic Oncology, Clínica Universitaria Colombia and Clínica Los Nogales, Bogotá, Colombia
  3. 3Department of Gynecology and Obstetrics, section of Gynecologic Oncology, Fundación Santa Fe de Bogotá, Bogotá, Colombia
  4. 4Gynecologic Oncology, Clinica ASTORGA, Medellin, Colombia
  1. Correspondence to Dr David Viveros-Carreño, Gynecologic Oncology, Instituto Nacional de Cancerología, Bogota, Colombia; dviverosc{at}


Objective The objective of this systematic review was to assess the incidence of lymph node metastasis in patients with clinically presumed early-stage low-grade serous ovarian cancer that underwent primary surgical treatment.

Methods This study was registered in PROSPERO (CRD42022308923). A systematic literature review was conducted following the Meta-analyses Of Observational Studies in Epidemiology (MOOSE) checklist. PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Ovid, and Scopus databases were searched since inception and up to March 2022. The inclusion criteria were: pathological confirmation of low-grade serous ovarian cancer (clinically presumed FIGO 2014 stages I-IIA at time of surgery) that underwent primary surgical treatment, including pelvic and/or para-aortic lymph node dissection.

Results The search identified 3763 articles; 59 were considered potentially eligible after removing duplicates, and eight studies finally met the selection criteria. In total, 35 of 277 (12.6%) patients had lymph node metastasis, and only four studies reported upstaging due to lymph node metastasis in 16 of 153 (10.5%) patients. None of the eight studies included reported the rate of complications or complications specifically for the subgroup of patients with early-stage low-grade tumors.

Conclusion In patients with early-stage low-grade serous ovarian cancer, lymph node assessment should be discussed when counseling for primary surgical staging.

  • ovarian cancer
  • lymph nodes
  • cystadenocarcinoma, serous

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Contributors DV-C: conceptualization, investigation, methodology, writing - original draft, writing - review, editing and responsible for the overall content as guarantor. JR: data curation, formal analysis, investigation, methodology, writing - review, and editing. RP: conceptualization, methodology, formal analysis, writing - review and editing, supervision.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.