| Background and ObjectiveOvarian cancer is a common malignancy of the female reproductive system.Lymph node metastasis is one of the common metastatic pathways of ovarian cancer.Clinical Practice Guidelines in Oncology Ovarian Cancer Including Fallopian Tube Cancer and Primary Peritoneal Cancer 2018 had recommended that the satisfactory debulking surgery for patients with phase IIIB epithelial ovarian cancer should contain systematic lymphadenectomy,and all enlarged lymph nodes should be removed during the debulking surgery.However,the NCCN guidelines do not provide clear recommendations on the need for lymph node resection in patients with stage IIIC/IV epithelial ovarian cancer who have no enlarged lymph nodes preoperatively or intraoperatively.In this study,the effect of lymphadenectomy on intraoperative conditions,perioperative complications and prognosis of patients with stage IIIC/IV epithelial ovarian cancer during cytoreductive surgery was studied,and the clinical value of lymphadenectomy for patients with advanced epithelial ovarian cancer was analyzed,so as to provide reference for the selection of surgical scheme for patients with advanced ovarian cancer.Materials and MethodsA total of 92 patients with stage IIIC/IV epithelial ovarian cancer who underwent cytoreductive surgery from January 1,2013 to December 31,2013,in the department of gynaecology at the first affiliated hospital of Zhengzhou university were collected as the research object.All patients were required to receive gynecological examination,tumor marker detection,chest and whole abdomen enhanced CT examination,ascites cytology examination or pathological biopsy to comprehensively assess the condition before surgery.Retroperitoneal lymph nodes of all enrolled patients were not enlarged by preoperative enhanced abdominal CT evaluation and intraoperative exploration.According to the evaluation results,after discussion by more than two gynecological oncologists,primary debulking surgery(PDS)or interval debulking surgery after 2-3 cycles of chemotherapy with paclitaxel liposomes combined with carboplatin regimen(NACT-IDS)were determined.According to whether resection of retroperitoneal lymph nodes in the process of cytoreductive surgery the patients were divided into lymphadenectomy group(observation group)and lymph node unresected group(control group),and according to the systematic removal of pelvic and para-aortic lymph nodes the observation group is divided into systematic lymphadenectomy group(SL)and unsystematic lymphadenectomy group(USL).Systematic pelvic and para-aortic lymph node resection was performed in the SL group,retroperitoneal lymph node sampling was performed in the USL group,and retroperitoneal lymph node resection was not performed in the control group.Patients in each group were recorded for age,pathological type,staging,operative time,bleeding volume,complications,median progression-free survival(PFS),total survival(OS),etc.,and their prognosis was analyzed.All patients were treated with PT chemotherapy every 3 weeks post operation.During the period of chemotherapy,patients’ reactions to chemotherapy and postoperative complications were observed and corresponding treatment was given in time.Regular follow-up was conducted after treatment,once every 3 months within 2 years,once every 6 months after 2 years and once every year after 3 years.Outpatient follow-up or telephone follow-up was adopted.The follow-up included the patient’s medical history,gynecological examination,blood routine,liver and kidney function,the detection of tumor markers,electrocardiogram,pelvic ultrasonography,chest and abdomen enhanced CT or PET-CT examination.All patients were followed until death or until the end of follow-up.The follow-up was completed on December 31,2018.Results1.Comparison of general data: there was no statistically significant difference in the general data of the patients(such as age,FIGO stage,pathological type,etc.)(P>0.05).2.Intraoperative blood loss,operation time and postoperative hospitalization time: compared with the control group,whose average intraoperative blood loss was(171.1± 89.2)ml and the average operation time was(2.87± 0.51)hours,the observation group was(263.6 ±103.4)ml and(3.38± 0.84)hours,the differences were statistically significant(P <0.05).The mean postoperative hospitalization time of patients in the two groups was(10.6± 2.1)days and(10.5± 2.5)days,respectively,and the difference was not statistically significant(P > 0.05).The average operation time of the SL group was(3.67± 0.87)hours,and that of the USL group was(3.10± 0.74)hours.The operation time of the USL group was shorter than that of the SL group,and the difference was statistically significant(P<0.05).The mean intraoperative blood loss(271.9± 101.8)ml in SL group and the mean postoperative hospital stay(10.4 ±2.3)days;the mean intraoperative blood loss(255.7± 106.3)ml in USL group and the mean postoperative hospital stay(10.8± 1.8)days,the difference was not statistically significant(P > 0.05).3.Complication comparison: the incidence of intraoperative and postoperative complications within 2 weeks in the observation group was higher than that in the control group(23.6% vs.10.8%),and the difference was not statistically significant(P > 0.05).The incidence of postoperative complications in SL group was higher than that in USL group(25.9%VS21.4%),and the difference was not statistically significant(P > 0.05).Lymphatic retention cyst occurred only in the observation group,and the difference was statistically significant(P < 0.05).The incidence of lymphatic retention cyst in SL group was significantly higher than that in USL group(55.6% vs 28.6%),and the difference was statistically significant(P < 0.05).4.Comparison of positive rate of lymph node metastasis: postoperative pathological examination showed that the positive rate of lymph node in SL group was higher than that in USL group(48.1% vs.42.9%),the difference was not statistically significant.(χ2=0.155,P > 0.05).5.Comparison of survival conditions: the median progression-free survival period in the observation group was 33 months,the median overall survival period was 51 months,and the control group was 31 months and 55 months,respectively,with no statistically significant difference(P > 0.05).Observation group 1 year,2 years,3 years,5 years survival rates were 100%,90.9%,76.4%,45.5%,control group 1 year,2 years,3 years,5 years survival rates were 91.9%,86.5%,78.4%,40.5%,statistical analysis,according to the observation group 1 year survival rate is higher than the control group(100% VS91.9 %),the difference was statistically significant(P < 0.05),the 2 year survival rate,the 5-year survival rate were higher than the control group(90.9% VS86.5 %,45.5% VS 40.5 %),The 3-year survival rate was lower than the control group(76.4%VS78.4%),but the differences were not statistically significant.The progression-free survival period of the SL group was 33 months,and the overall survival period was 51 months;the progression-free survival period of the USL group was 31 months,and the overall survival period(OS)was 44 months,and the difference was not statistically significant(P < 0.05).The 1-year,2-year,3-year and 5-year survival rates of the SL group were 100%,88.9%,85.2% and 48.1%,respectively.The 1-year,2-year,3-year and 5-year survival rates of the USL group were 96.4%,89.3%,67.9% and 39.3%,respectively.There was no statistically significant difference between the two groups(P > 0.05).Conclusions1.Stage IIIC/IV epithelial ovarian cancer patients without enlarged lymph nodes still have the possibility of lymph node metastasis.2.For patients with stage IIIC/IV epithelial ovarian cancer who have no enlarged lymph nodes on preoperative imaging and intraoperative exploration,lymph nodes can be left unresected in satisfactory subcellular surgery. |
PDF Full Text Request