Lymphadenectomy Offers No Additional Benefit For Advanced Ovarian Cancer Care

The balance of benefits and harms does not favour systematic use of lymphadenectomy in stage IIB–IV ovarian cancer patients without lymph node metastases

medwireNews: Lymphadenectomy after macroscopically complete resection for advanced ovarian cancer in women without lymph node disease does not significantly improve survival but does raise the risk of postoperative complications, say the LION investigators.

“The results of this prospectively randomized, adequately powered, international, multicenter trial add level 1 evidence to the long-standing discussion about the role of lymphadenectomy in advanced ovarian cancer and once more underline the importance of the use of proper research methods in generating clinical evidence”, write Philipp Harter, from Kliniken Essen-Mitte in Germany, and team.

As reported in The New England Journal of Medicine, median overall survival was a comparable 65.5 months for the 323 patients with FIGO stage IIB–IV disease who underwent systematic pelvic and para-aortic lymphadenectomy alongside their ovarian cancer debulking surgery and 69.2 months for the 324 participants who did not. 

Median progression-free survival was 25.5 months in both treatment arms.

Of concern, “lymphadenectomy resulted in treatment burden and harm to patients”, the researchers say, resulting in a significantly higher 60-day rate of mortality, at 3.1% versus 0.9% among controls.

Patients who received lymphadenectomy had a significantly higher rate of repeat laparotomy for postoperative complications, at 12.4% versus 6.5% of those who did not undergo the additional procedure.

Lymphadenectomy was also associated with a significantly longer surgery time (median, 340 vs 280 min), significantly greater blood loss (median, 650 vs 500 mL), significantly higher requirement for transfusion (63.7 vs 56.0%) and significantly more need for intermediate or intensive care unit admission (77.6 vs 69.0%). 

Patients who underwent lymphadenectomy were also significantly more likely to experience infection requiring antibiotics (25.8 vs 18.6%), as well as develop asymptomatic (4.3 vs 0.3%) or symptomatic (3.1 vs 0.0%) cysts at discharge. 

The authors of a linked editorial believe that the lack of overall survival benefit with lymphadenectomy in the LION trial is “consistent with the concept that it is the inability to control intraabdominal disease that is the most frequent cause of ovarian cancer-related illness and death.”

Moreover, any potentially increased rate of disease recurrence in the lymph nodes did not affect survival among these women”, say Eric Eisenhauer, from Massachusetts General Hospital in Boston, USA, and Dennis Chi, from the Memorial Sloan Kettering Cancer Center in New York, USA.

The editorialists therefore conclude: “Women with ovarian cancer in whom complete primary cytoreduction is achieved have the best prognosis and longest survival.  

“The procedures required to achieve complete cytoreduction already have attendant risks, and eliminating ineffective techniques such as systematic lymphadenectomy is prudent to improve patients’ overall recovery.” 

 

References 

Harter P, Sehouli J, Lorusso D, et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms . N Engl J Med; 380:822–832. DOI: 10.1056/NEJMoa1808424  

Eisenhauer EL, Chi DS. Ovarian cancer surgery – heed this LION’s roar . N Engl J Med; 380:871–873. DOI: 10.1056/NEJMe1900044

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