Systematic pelvic and para-aortic lymphadenectomy during cytoreductive surgery in advanced ovarian cancer: potential benefit on survival.

A case-control study was carried out to evaluate the potential benefit on survival of systematic pelvic and para-aortic lymphadenectomy (SL) during primary or secondary cytoreductive surgery on patients with Stage IIIC-IV of epithelial ovarian cancer. A total of 105 optimally cytoreduced (macroscopic disease < 2 cm on peritoneal surfaces) patients were divided into two groups: Group A, consisting of 60 patients (30 previously untreated and 30 pretreated at other institutions), underwent SL; Group B, consisting of 45 patients (23 previously untreated and 22 pretreated at other institutions), did not undergo SL. Consideration was given toward the inclusion of previously untreated and pretreated patients in two different groups for survival analysis. Each group had statistically equivalent stage, histology, grading, age, performance status, largest diameter metastasis (> 10 cm), type of surgery, and variety of cytoreductive operations performed. Group A patients had a longer median operation time than Group B patients (P = 0.01). SL could be carried out with an acceptable morbidity and no mortality. All 105 patients received postoperative chemotherapy including Carboplatin. Comparison on survival revealed that SL significantly improved the survival of previously untreated patients (P < 0.001). Cox's proportional analysis shows that SL was the most significant covariate, followed by stage of disease. The survival was not significantly different in Group A and Group B pretreated patients. Only stage of disease (III vs IV) significantly influenced the survival (P < 0.01). The results of the present study show that aggressive surgical cytoreduction with SL may be advisable only in previously untreated patients optimally cytoreduced. We also suggest the need for a randomized, prospective study to clarify the clinical role of SL.