Highlights
- •Presumed early-stage ovarian carcinoma had lymph node involvement in 8.4% of cases.
- •Histology and grade rather than lymph node status determined the indication of adjuvant chemotherapy.
- •High grade histology was the only variable that negatively impacted disease-free survival in univariate analysis.
Abstract
Objective
Our objective was to analyze the prevalence of lymph node metastasis in early-stage
ovarian carcinoma after systematic lymph node dissection and its impact on indication
of adjuvant chemotherapy.
Study design
We evaluated a series of 765 patients diagnosed with ovarian carcinoma who underwent
surgical treatment from February 2007 to December 2019. Patients with peritoneal disease
and incomplete surgical staging were excluded. All cases underwent systematic pelvic
and para-aortic lymphadenectomy up to the renal vessels.
Results
A total of 142 cases were analyzed. Median pelvic and para-aortic lymph node dissected were 30 (range, 6–81) and 21 (range, 3–86), respectively.
Twelve (8.4%) patients had metastatic lymph nodes – high-grade serous, 10.4% (5/48);
clear cell, 17.2% (5/29) and endometrioid, 5.7% (2/35). Any other histology (low grade
serous, mucinous, carcinosarcoma or mixed) had lymph node metastasis. Notably, 50%
of patients with positive lymph nodes had preoperative suspicious lymph nodes in imaging.
The median hospital stay length was 6 days (range, 2–33) and 4.2% cases had grade ≥ 3
complications. A total of 110 (77.6%) patients underwent adjuvant chemotherapy and
all cases had indication of adjuvant chemotherapy after histological type, despite
the lymph node status. After a median follow-up of 52.5 months, we noted 24 (16.9%)
recurrences. The 5-year recurrence-free survival and overall survival were 86.4% and
98.1%, respectively. High grade histology was the only variable that negatively impacted
disease-free survival in univariate analysis [HR 4.70 (95%CI: 1.09–20); p = 0.037].
Conclusions
We found a positive lymph node rate of less than 10% after lymphadenectomy in presumed
early-stage ovarian carcinoma. Lymph node status was not determinant for adjuvant
chemotherapy.
Keywords
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Article info
Publication history
Published online: September 06, 2022
Accepted:
August 30,
2022
Received in revised form:
June 27,
2022
Received:
April 22,
2022
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
