Risks and benefits of systematic lymphadenectomy during interval debulking surgery for advanced high grade serous ovarian cancer
Menée sur la période 2005-2018 auprès de 133 patientes atteintes d'un carcinome séreux de haut grade de l'ovaire recevant une chimiothérapie néoadjuvante, cette étude évalue l'intérêt, du point de vue de la survie sans récidive, de la survie globale et du taux de complications, d'une lymphadénectomie au cours d'une chirurgie de réduction tumorale d'intervalle
Background: Lymphadenectomy is debated in patients with ovarian cancer. The aim of our study was to evaluate the impact of lymphadenectomy in patients with high-grade serous ovarian cancer receiving neoadjuvant chemotherapy (NACT) followed by interval debulking surgery (IDS). Methods: A retrospective, unicentric study including all patients undergoing NACT and IDS was carried out from 2005 to 2018. Patients with and without lymphadenectomy were compared in terms of recurrence free survival (RFS), overall survival (OS), and complication rates. Results: We included 203 patients. Of these, 133 had a lymphadenectomy (65.5%) and 77 had involved nodes (57.9%). Patients without a lymphadenectomy were older, had a more extensive disease and less complete CRS. No differences were noted between the lymphadenectomy and no lymphadenectomy group concerning 2-year RFS (47.4% and 48.6%, p = 0.87, respectively) and 5-year OS (63.2% versus 58.6%, p = 0.41, respectively). Post-operative complications tended to be more frequent in the lymphadenectomy group (18.57% versus 31.58%, p = 0.09). In patients with a lymphadenectomy, survival was significantly altered if the nodes were involved (positive nodes: 2-year RFS 42.5% and 5-year OS 49.4%, negative nodes: 2-year RFS 60.7% and 5-year OS 82.2%, p = 0.03 and p < 0.001, respectively). Conclusion: Lymphadenectomy during IDS does not improve survival and increases post-operative complications.