1. Pelvic and paraaortic lymphadenectomy in advanced ovarian cancer patients provided no overall or progression-free survival benefits compared to patients not undergoing lymphadenectomy.
2. Serious postoperative complications, including postoperative death, occurred at greater rates in patients undergoing systematic lymphadenectomy.
Evidence Rating Level: 1 (Excellent)
Study Rundown: Patients with advanced ovarian cancer generally receive surgery to remove all macroscopically visible tumor followed by chemotherapy. Some studies have suggested systematic pelvic and paraaortic lymphadenectomy provides additional survival benefit in these patients. The Lymphadenectomy in Ovarian Neoplasms (LION) trial sought to evaluate the survival benefit of systematic lymphadenectomy in patients with gross resection of advanced ovarian neoplasm. The median overall and progression-free survival rates did not differ between the groups receiving and not receiving lymphadenectomy, and patients undergoing lymphadenectomy experienced significantly greater postoperative complication rates.
This study provides compelling evidence that after complete macroscopic tumor resection, further lymphadenectomy in advanced ovarian cancer patients is unnecessarily morbid and provides no survival advantage. A limitation of this trial is generalizability as patients were treated at specialized surgical centers.
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