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Role of systematic lymphadenectomy at the time of interval debulking surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection
  1. Dimitrios Nasioudis,
  2. Stefan Gysler,
  3. Nawar A Latif,
  4. Robert L Giuntoli II,
  5. Sarah H Kim and
  6. Emily M Ko
    1. Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
    1. Correspondence to Dr Dimitrios Nasioudis, Division of Gynecologic Oncology, University of Pennsylvania, Philadelphia, PA 19104, USA; dimitrios.nasioudis{at}pennmedicine.upenn.edu

    Abstract

    Objective To evaluate the role of systematic lymphadenectomy at the time of interval cytoreductive surgery for patients with advanced-stage epithelial ovarian carcinoma who achieved complete gross resection.

    Methods The National Cancer DataBase was accessed, and patients diagnosed between 2010 and 2015 with advanced-stage ovarian carcinoma who underwent interval cytoreductive surgery and achieved complete gross resection were identified. Patients who did not undergo lymphadenectomy and those who underwent systematic lymphadenectomy (defined as at least 20 lymph nodes removed) were selected for further analysis. Median overall survival was compared with the log-rank test and controlled for a priori selected confounders.

    Results A total of 1060 patients were identified. Systematic lymphadenectomy was performed for 125 (11.8%) patients with a median of 29 lymph nodes (range 20–72) removed. Rate of lymph node metastasis was 62.4%. Patients who underwent systematic lymphadenectomy had higher rate of unplanned readmission (8.9% vs 1.6%, p<0.001), and median hospital stay (6 vs 4 days, p<0.001). Median overall survival for patients who did and did not undergo systematic lymphadenectomy was 44.2 and 40.4 months, respectively, p=0.40. After controlling for confounders, performance of systematic lymphadenectomy was not associated with better survival (HR=0.98, 95% CI 0.80 to 1.19).

    Conclusion Systematic lymphadenectomy is rarely performed at the time of interval cytoreductive surgery and not associated with a survival benefit for patients who achieved complete gross resection.

    • Ovarian Cancer
    • Lymph Nodes

    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

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    Data availability statement

    Data may be obtained from a third party and are not publicly available. Data obtained from the American College of Surgeons.

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    Footnotes

    • Contributors DN: conception, data acquisition, data management, statistical analysis, critical analysis, drafting/final editing, guarantor. NL, SK, SG, RLG: critical analysis, drafting/final editing; EMK: supervision, critical analysis, drafting/final 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 EMK received grants from Tesaro, Faeth, and Bristol-Meyers Squibb outside the submitted work.

    • 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.