How to Cite
Abstract
Introduction. Surgical staging, including pelvic and para-aortic lymphadenectomy, is recommended for patients with early-stage ovarian cancer. Detection of lymph node metastasis may change the treatment plan. However, the therapeutic role of pelvic and para-aortic lymphadenectomy is still under debate, and this procedure may increase the risk of intra- and postoperative complications.
Aim. To determine the rate of lymph node metastasis in patients with early-stage ovarian cancer. To estimate the impact of lymphadenectomy on treatment planning and recurrence-free survival.
Materials and Methods. We retrospectively analyzed the outcomes of ovarian cancer patients with clinical stage I-IIA who underwent surgical staging, including pelvic and para-aortic lymphadenectomy, in the Department of Onco-Gynecology from 2018 to 2023. The primary endpoint of the study was the incidence of detection of lymph node metastases in early-stage ovarian cancer.
Results. The study included a total of 99 female patients. According to surgical staging, tumor cells were found in cytology — 12.1 %, pelvic and paracolic gutters — 4 %, fallopian tubes — 4 %, omentum — 5.1 %, contralateral ovary — 2 %. The rate of lymph node metastases was 7.1 %. Upstaging occurred in 31.3 % of patients. In 99 patients, 11.1 % had their treatment plan changed due to metastases found during surgical staging. The detection of lymph node metastases did not influence the change in treatment plan with regard to the administration of standard adjuvant chemotherapy in the study group. PARP-i maintenance was only indicated in one patient with HRD-positive metastases in para-aortic lymph nodes. The overall rate of intraoperative complications was 3 %, postoperative complications — 38.4 %, major postoperative complications — 6.1 %.
After a median follow-up of 32.1 months (96 % of patients), progression-free survival was 93.3 % and all patients followed were alive at the time of analysis.
Conclusion. The rate of retroperitoneal lymph node metastases in patients with early-stage ovarian cancer was 7.1 %, detected after pelvic and para-aortic lymphadenectomy This did not affect the adjuvant treatment plan. Prospective randomized trials are required to assess the therapeutic role of lymphadenectomy in early-stage ovarian cancer.
References
Bray F., Laversanne M., Sung H., et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries CA: a cancer journal for clinicians. 2024; 74(3): 229-263.-DOI: 10.3322/caac.21834.-URL: https://pubmed.ncbi.nlm.nih.gov/38572751/.
Жорданиа К.И., Калиничева Е.В., Моисеев А.А. Рак яичников: эпидемиология, морфология и гистогенез. Онкогинекология. 2017; 3: 26-32.-URL: https://www.osors.ru/oncogynecology/JurText/j2017_3/03_17_26.pdf.
[Zgordania K.I., Kalinicheva E.V., Moiseev A.A. Ovarian cancer: epidemiology, morphology and histogenesis. Oncogynecology. 2017; 3: 26-32.-URL: https://www.osors.ru/oncogynecology/JurText/j2017_3/03_17_26.pdf (in Rus)].
Powless C.A., Aletti G.D., BakkumGamez J.N., et al. Risk factors for lymph-node metastasis in apparent early-stage epithelial ovarian cancer: implications for surgical staging. Gynecol Oncol. 2011; 122(3): 536-540.-DOI: 10.1016/j.ygyno.2011.05.001.-URL: https://pubmed.ncbi.nlm.nih.gov/21636114/.
Kleppe M., Wang T., Van Gorp T., et al. Lymph node metastasis in stages I and II ovarian cancer: a review. Gynecol Oncol. 2011; 123(3): 610-614.-DOI: 10.1016/j.ygyno.2011.09.013.-URL: https://pubmed.ncbi.nlm.nih.gov/21982047/.
Рак яичников/рак маточной трубы/первичный рак брюшины. Клинические рекомендации. 2020.-URL: https://oncology-association.ru/wp-content/uploads/2020/09/rak_jaichnikov_matochnoj_truby.pdf.
[Ovarian cancer/fallopian tube cancer/primary peritoneal cancer. Clinical recommendations. 2020.-URL: https://oncology-association.ru/wp-content/uploads/2020/09/rak_jaichnikov_matochnoj_truby.pdf (In Rus)].
Шевчук А.С., Новикова Е.Г., Каприн А.Д. Лапароскопическая хирургия в лечении раннего рака яичников: эффективность и безопасность. Акушерство и гинекология: Новости. Мнения. Обучения. 2017; 15 (1): 49-55.-URL: https://acu-gin-journal.ru/ru/journals_acu/16.html?SSr=460134da7901ffffffff27c__07e80a11012e3a-6cfb.
[Shevchuk A.S., Novikova E.G., Kaprin A.D. Laparoscopic surgery in early stage ovarian cancer: safety and efficacy. Obstatrics and Gynecoclogy. 2017; 15 (1): 49-55.-URL: https://acu-gin-journal.ru/ru/journals_acu/16.html?SSr=460134da7901ffffffff27c__07e80a11012e3a-6cfb (In Rus)].
Trimbos J.B., Vergote I., Bolis G., et al. Impact of adjuvant chemotherapy and surgical staging in early-stage ovarian carcinoma: European Organisation for Research and Treatment of Cancer-Adjuvant ChemoTherapy in Ovarian Neoplasm trial. J Nat Cancer Inst. 2003; 95(2): 113-125.-DOI: 10.1093/jnci/95.2.113.-URL: https://pubmed.ncbi.nlm.nih.gov/12529344/.
Trimbos B., Timmers P., Pecorelli S., et al. Surgical staging and treatment of early ovarian cancer: long-term analysis from a randomized trial. J Nat Cancer Inst. 2010; 102(13): 982-987.-DOI: 10.1093/jnci/djq149.-URL: https://pubmed.ncbi.nlm.nih.gov/20445161/.
Maggioni A., Benedetti Panici P., Dell'Anna T., et al. Randomised study of systematic lymphadenectomy in patients with epithelial ovarian cancer macroscopically confined to the pelvis. Br J Cancer. 2006; 95(6): 699-704.-DOI: 10.1038/sj.bjc.6603323.-URL: https://pubmed.ncbi.nlm.nih.gov/16940979/.
National Comprechensive Cancer Network. NCCN Guidelines. Ovarian Cancer/Fallopian Tube Cancer/Primary Peritoneal Cancer.-URL: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1453 (20.09.2024).
Harter P., Sehouli J., Lorusso D., et al. A randomized trial of lymphadenectomy in patients with advanced ovarian neoplasms. N Engl J Med. 2019; 380(9): 822-832.-DOI: 10.1056/NEJMoa1808424.-URL: https://pubmed.ncbi.nlm.nih.gov/30811909/.
Cheng A., Lang J. Survival analysis of lymph node resection in ovarian cancer: a population-based study. Front Oncol. 2020; 10: 355.-DOI: 10.3389/fonc.2020.00355.-URL: https://pubmed.ncbi.nlm.nih.gov/32266140/.
Bizzarri N., du Bois A., Fruscio R., et al. Is there any therapeutic role of pelvic and para-aortic lymphadenectomy in apparent early-stage epithelial ovarian cancer? Gynecol Oncol. 2021; 160(1): 56-63.-DOI: 10.1016/j.ygyno.2020.10.028.-URL: https://pubmed.ncbi.nlm.nih.gov/33168305/.
Городнова Т.В., Гусейнов К.Д., Бондарев Н.Э., et al. Роль лимфаденэктомии в лечении эпителиального рака яичников. Вопросы онкологии. 2018; 64(1): 102-109.-DOI: 10.37469/0507-3758-2018-64-1-102-109.-URL: https://voprosyonkologii.ru/index.php/journal/article/view/809?articlesBySameAuthorPage=1.
[Gorodnova T.V., Guseynov K.D., Bondarev N.E., et al. The role of lymphadenectomy in ovarian cancer treatment. Voprosy Onkologii = Problems in Oncology. 2018; 64(1): 102-109.-DOI: 10.37469/0507-3758-2018-64-1-102-109.-URL: https://voprosyonkologii.ru/index.php/journal/article/view/809?articlesBySameAuthorPage=1 (In Rus)].
Lago V., Minig L., Fotopoulou C., Incidence of lymph node metastases in apparent early-stage low-grade epithelial ovarian cancer: a comprehensive review. Int J Gynecol Cancer. 2016; 26(8): 1407-1414.-DOI: 10.1097/IGC.0000000000000787.-URL: https://pubmed.ncbi.nlm.nih.gov/27465900/.
Ledermann J.A., Matias-Guiu X., Amant F., et al. ESGO–ESMO–ESP consensus conference recommendations on ovarian cancer: Pathology and molecular biology and early, advanced and recurrent disease. Annals of Oncol. 2024; 35(3): 248-266.-DOI: 10.1016/j.annonc.2023.11.015.-URL: https://pubmed.ncbi.nlm.nih.gov/38307807/.
Chen J., Yin J., Li Y., et al. Systematic lymph node dissection may be abolished in patients with apparent early-stage low-grade mucinous and endometrioid epithelial ovarian cancer. Front in Oncol. 2021; 11: 705-720.-DOI: 10.3389/fonc.2021.705720.-URL: https://pubmed.ncbi.nlm.nih.gov/34552868/.
Montero-Macías R., Segura-Sampedro J.J., Rigolet P., et al. The role of systematic lymphadenectomy in low-grade serous ovarian cancer: a systematic review and meta-analysis. Cancers. 2024; 16(5): 955. DOI: 10.3390/cancers16050955.-URL: https://pubmed.ncbi.nlm.nih.gov/38473315/.
Тихоновская М.Н., Шевчук А.С. Исследование сторожевых лимфатических узлов при раннем раке яичников: первый опыт ФГБУ «Национальный медицинский исследовательский центр онкологии им. Н.Н. Блохина» Минздрава России. Тазовая хирургия и онкология. 2022; 12(3): 19-25.-DOI: 10.17650/2686-9594-2022-12-3-19-25.-URL: https://www.onco-surgery.info/jour/article/view/549.
[Tikhonovskaya M.N., Shevchuk A.S. Sentinel lymph node detection in early stage ovarian cancer: the primary experience in N.N. Blokhin NMRCO. Pelvic Surgery And Oncoclogy. 2022; 12(3): 19-25.-DOI: 10.17650/2686-9594-2022-12-3-19-25.-URL: https://www.onco-surgery.info/jour/article/view/549 (In Rus)].
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
© АННМО «Вопросы онкологии», Copyright (c) 2025