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Impact of lymphadenectomy and intra-operative tumor rupture on survival in early-stage mucinous ovarian cancers
  1. Soyoun Rachel Kim1,2,
  2. Ainhoa Madariaga3,
  3. Liat Hogen1,2,
  4. Danielle Vicus2,4,
  5. Allan Covens2,4,
  6. Carlos Parra-Herran5,
  7. Stephanie Lheureux3 and
  8. Lilian T Gien2,4
  1. 1Division of Gynecologic Oncology, Princess Margaret Cancer Centre/University Health Network/Sinai Health Systems, University of Toronto, Toronto, Ontario, Canada
  2. 2Obstetrics and Gynecology, University of Toronto, Toronto, Ontario, Canada
  3. 3Medical Oncology & Hematology, Princess Margaret Hospital Cancer Centre/University Health Networks/Sinai Health Systems, Toronto, Ontario, Canada
  4. 4Gynecologic Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
  5. 5Brigham and Women's Hospital, Boston, Massachusetts, USA
  1. Correspondence to Dr Lilian T Gien, Gynecologic Oncology, Odette Cancer Centre, Toronto, Ontario M4N 3M5, Canada; Lilian.Gien{at}


Objective Mucinous ovarian carcinoma is a rare subtype of epithelial ovarian cancer with scarce literature guiding its management. We aimed to investigate the optimal surgical management of clinical stage I mucinous ovarian carcinoma by examining the prognostic significance of lymphadenectomy and intra-operative rupture on patient survival.

Methods We conducted a retrospective cohort study of all pathology-reviewed invasive mucinous ovarian carcinomas diagnosed between 1999 and 2019 at two tertiary care cancer centers. Baseline demographics, surgical management details, and outcomes were collected. Five-year overall survival, recurrence-free survival, and the association of lymphadenectomy and intra-operative rupture on survival were examined.

Results Of 170 women with mucinous ovarian carcinoma, 149 (88%) had clinical stage I disease. Forty-eight (32%; n=149) patients had a pelvic and/or para-aortic lymphadenectomy, but only 1 patient with grade 2 disease was upstaged due to positive pelvic lymph nodes. Intra-operative tumor rupture was documented in 52 cases (35%). On multivariable analysis, after adjusting for age, final stage, and use of adjuvant chemotherapy, there was no significant association between intra-operative rupture with overall survival (HR 2.2 (0.6–8.0); p=0.3) or recurrence-free survival (HR 1.3 (0.5–3.3); p=0.6), or lymphadenectomy with overall survival (HR 0.9 (0.3–2.8); p=0.9) or recurrence-free survival (HR 1.2 (0.5–3.0); p=0.7). Advanced stage was the only factor that was significantly associated with survival.

Conclusions In clinical stage I mucinous ovarian carcinoma, systematic lymphadenectomy has low utility, as very few patients are upstaged and recurrence typically occurs in the peritoneum. Furthermore, intra-operative rupture does not appear to independently confer a worse survival, and therefore these women may not benefit from adjuvant treatment based on rupture alone.

  • Cystadenocarcinoma, Mucinous
  • Lymph Nodes

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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  • Twitter @AinhoaMada, @stephanielheur5

  • Contributors SRK: data curation, formal analysis, project administration, visualization, writing—original draft, writing—review and editing. AM: data curation, investigation, methodology, writing—review and editing. LH: conceptualization, investigation, writing—review and editing. DV: investigation, writing—review and editing. AC: investigation, writing—review and editing. CP-H: data curation, investigation, writing—review and editing. SL: conceptualization, investigation, writing—review and editing. LTG: guarantor, conceptualization, formal analysis, funding acquisition, project administration, investigation, methodology, supervision, writing—review and editing.

  • 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.