LION: lymphadenectomy fails to up OS in advanced ovarian cancer

  • Harter P & al.
  • N Engl J Med
  • 28 Feb 2019

  • curated by Deepa Koli
  • Univadis Clinical Summaries
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Takeaway

  • 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.

Study design

  • 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.

Key results

  • 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).

Limitations

  • Poorest prognostic group was not included.

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