The Therapeutic Impact of Lymphadenectomy in the Management of Epithelial Ovarian Cancer: A Single Institution Experience
Kiran Abhijit Kulkarni
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
T. S. Premalatha *
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
G. Sumangala
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
Geeta Acharya
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
Sumithra Selvam
Department of Biostatistics, St. John’s Medical College, Bengaluru, India.
Vishakha C. Bidkar
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
Julian Crasta
Department of Pathology, St. John’s Medical College, Bengaluru, India.
Elizabeth Vallikad
Department of Gynecologic Oncology, St. John’s Medical College, Bengaluru, India.
*Author to whom correspondence should be addressed.
Abstract
Aim: To assess the impact of lymphadenectomy on overall survival (OS) and progression-free survival (PFS) in patients with epithelial ovarian cancer (EOC).
Study Design: Retrospective observational study.
Place and Duration of Study: All patients diagnosed with epithelial ovarian, fallopian tube or primary peritoneal cancer treated in the Department of Gynecologic Oncology in a tertiary care hospital in South India from January 2012 onwards. All patients’ follow up data was prospectively updated till 30 April 2017.
Methodology: We included 83 patients who met the inclusion criteria. The patients were classified into two groups based on the number of lymph nodes (LN) harvested (< 30 lymph nodes and > 30 nodes). Lymphadenectomy was considered systematic (SLND) when the harvest was > 30 nodes on the pathologic specimen.
Results: Out of the 83 cases, complete SLND was done in 43 (51.8%) cases and the median number of removed lymph nodes was 44 (IQR 25– 75%: 38–52). Among the women who underwent a complete SLND, the median OS was 55.7 months vs 49.0 months among those where the lymph node harvest count was < 30 (P value – 0.16). The median PFS in the complete SLND group was 49.0 months and 43.46 months for the other group with no significant difference (P value – 0.18). Though there was no significant difference in OS and PFS, there was a trend towards improved survival with complete SLND group beyond 500 days.
Conclusion: Complete SLND group showed a trend towards improved OS and PFS, though statistically not significant. Further investigation is warranted.
Keywords: Systematic lymphadenectomy, epithelial ovarian cancer, survival, cytoreduction.