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OUTCOMES IN EARLY STAGE OVARIAN CANCER WITHOUT LYMPHADENECTOMY: A RETROSPECTIVE COHORT STUDY IN A REFERENCE ONCOLOGICAL HOSPITAL
Ovarian carcinoma represents the most aggressive gynecological tumor. Most metastatic dissemination of this tumor occurs through transcelomic route or lymphatic vessels. The incidence of nodal metastases is substantially lower in neoplasms detected in early stages compared to more advanced stages. The efficacy of lymphadenectomy in early stages is not well established, yet it is routinely advocated, based on weak evidence to date.
The primary objective of this study was to report progression-free survival and overall survival in patients with early-stage ovarian tumors who did not undergo pelvic and para-aortic lymphadenectomy.
A single-center retrospective cohort study reporting the role of not performing pelvic and para-aortic lymphadenectomy in the outcomes of disease-free progression and overall survival in early-stage ovarian tumors FIGO IA, IB, and IC. Women with an initial diagnosis of ovarian tumor between 2009 and 2018 were included in the study. Patients should have completed intraperitoneal staging and have been operated on by an oncological surgeon. FIGO stages II to IV, borderline and pelvic and para-aortic lymph nodes > 10 mm at CT were excluded from the study, as well as incomplete intraperitoneal staging, lack of information on adjuvant therapy, synchronous tumors and previous malignant neoplasms.
Of a total of 385 patients with ovarian tumors, 47 met the inclusion criteria and underwent complete intraperitoneal staging with peritoneal lavage, hysterectomy, bilateral salpingoophorectomy, omentectomy, peritoneal biopsy. Pelvic and para-aortic lymphadenectomy was not performed. The median age at diagnosis was 51 years. The most frequent histological subtype in the sample were serous (42%). The stages at diagnosis were IA (68%), IB (4%) and IC (27%). The median follow-up of these patients was 72 months. The progression-free survival at 12 months, 24 months and five years was 100%, 97% and 93%, respectively, and the overall survival at 12 months, 24 months and five years was 100%, 100% and 97%, respectively.
Not performing lymphadenectomy in the surgical staging of early stages of ovarian cancer seems to have clinical outcomes like those of patients who underwent this procedure. Despite possible biases and a low level of evidence inherent in a retrospective study, we hypothesized that lymphadenectomy does not appear to have significant benefits in the clinical outcomes of early-stage ovarian tumors.
ovarian, lymphadenectomy, cancer
FELIPE FRANCO DE CAMPOS , HANDER KELLER MADUREIRA RABELO, LUIZA ORTIZ DAVID, JOSÉ CLEMENTE LINHARES