- In patients with advanced ovarian cancer, systematic pelvic and paraaortic lymphadenectomy after complete macroscopic resection does not improve survival and results in higher incidence of postoperative complications.
Why this matters
- Previous retrospective analyses have suggested a benefit of lymphadenectomy.
- Randomized multicenter LION study of 647 patients with newly diagnosed advanced ovarian cancer (International Federation of Gynecology and Obstetrics stage IIB-IV).
- Patients with normal lymph nodes after complete macroscopic resection were randomly assigned intraoperatively to receive lymphadenectomy or no lymphadenectomy.
- Funding: Deutsche Forschungsgemeinschaft; the Austrian Science Fund.
- Median number of 57 nodes (pelvic, 35; paraaortic, 22) were removed in patients who underwent lymphadenectomy.
- Survival was not significantly different in no-lymphadenectomy vs lymphadenectomy group:
- median OS: 69.2 vs 65.5 months (HR, 1.06; P=.65); and
- median PFS: 25.5 months in both groups (HR, 1.11; P=.29).
- Lymphadenectomy increased postoperative complications:
- median duration of surgery: 340 vs 280 minutes (P<.001>
- median blood loss: 650 vs 500 mL (P<.001>
- repeat laparotomy: 12.4% vs 6.5% (P=.01; and the main reason for repeat laparotomy was bowel leakage or fistula, at 22 vs 8 events); and
- 60-day mortality: 3.1% vs 0.9% (P=.049).
- Poorest prognostic group was not included.