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KMID : 1137020220330050069
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Journal of Gynecologic Oncology
2022 Volume.33 No. 5 p.69 ~ p.69
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Systematic lymph node dissection during interval debulking surgery for advanced epithelial ovarian cancer: a systematic review and meta-analysis
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Caruso Giuseppe
Palaia Innocenza
Bogani Giorgio
Tomao Federica
Perniola Giorgia
Panici PierLuigi Benedetti
Muzii Ludovico
Di Donato Violante
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Abstract
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Objective: To evaluate the efficacy and safety of systematic lymph node dissection (SyLND) at the time of interval debulking surgery (IDS) for advanced epithelial ovarian cancer (AEOC).
Methods: Systematic literature review of studies including AEOC patients undergoing SyLND versus selective lymph node dissection (SeLND) or no lymph node dissection (NoLND) after neoadjuvant chemotherapy (NACT). Primary endpoints included progression-free survival (PFS) and overall survival (OS). Secondary endpoints included severe postoperative complications, lymphocele, lymphedema, blood loss, blood transfusions, operative time, and hospital stay.
Results: Nine retrospective studies met the eligibility criteria, involving a total of 1,660 patients: 827 (49.8%) SyLND, 490 (29.5%) SeLND, and 343 (20.7%) NoLND. The pooled estimated hazard ratios (HR) for PFS and OS were, respectively, 0.88 (95% confidence interval [CI]=0.65?1.20; p=0.43) and 0.80 (95% CI=0.50?1.30; p=0.37). The pooled estimated odds ratios (ORs) for severe postoperative complications, lymphocele, lymphedema, and blood transfusions were, respectively, 1.83 (95% CI=1.19?2.82; p=0.006), 3.38 (95% CI=1.71?6.70; p<0.001), 7.23 (95% CI=3.40?15.36; p<0.0001), and 1.22 (95% CI=0.50?2.96; p=0.67).
Conclusion: Despite the heterogeneity in the study designs, SyLND after NACT failed to demonstrate a significant improvement in PFS and OS and resulted in a higher risk of severe postoperative complications.
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KEYWORD
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Ovarian Cancer, Neoadjuvant Chemotherapy, Cytoreductive Surgery, Lymphadenectomy, Survival
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