Objective

To investigate whether systematic pelvic and para-aortic lymphadenectomy offers superior survival rates in patients with advanced epithelial ovarian cancer (EOC), tubal, or peritoneal cancer.

Methods

We searched the electronic databases PubMed (from 1996), Cochrane Central Register of Controlled trials (from 1996), and Scopus (from 2004) to September 2021. We considered randomised controlled trials (RCTs) comparing systematic pelvic and para-aortic lymphadenectomy with no lymphadenectomy in patients with advanced EOC. Primary outcomes were overall survival and progression-free survival. Secondary outcomes were peri-operative morbidity and operative mortality. The revised Cochrane tool for randomised trials (RoB 2 tool) was utilised for the risk of bias assessment in the included studies. We performed time-to-event and standard pairwise meta-analyses, as appropriate.

Results

Two RCTs with a total of 1074 patients were included in our review. Meta-analysis demonstrated similar overall survival (HR = 1.03, 95% CI [0.85–1.24]; low certainty) and progression-free survival (HR = 0.92, 95% CI [0.63–1.35]; very low certainty). Regarding peri-operative morbidity, systematic lymphadenectomy was associated with higher rates of lymphoedema and lymphocysts formation (RR = 7.31, 95% CI [1.89–28.20]; moderate certainty) and need for blood transfusion (RR = 1.17, 95% CI [1.06–1.29]; moderate certainty). No statistically significant differences were observed in regard to other peri-operative adverse events between the two arms.

Conclusions

Systematic pelvic and para-aortic lymphadenectomy is likely associated with similar overall survival and progression-free survival compared to no lymphadenectomy in optimally debulked patients with advanced EOC. Systematic lymphadenectomy is also associated with an increased risk for certain peri-operative adverse events. Further research needs to be conducted on whether we should abandon systematic lymphadenectomy in completely debulked patients during primary debulking surgery.

中文翻译：

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系统性盆腔和腹主动脉旁淋巴结清扫术在晚期上皮性卵巢癌、输卵管癌和腹膜癌患者治疗中的作用：系统评价和荟萃分析

客观的

研究系统性盆腔和腹主动脉旁淋巴结清扫术是否为晚期上皮性卵巢癌 (EOC)、输卵管癌或腹膜癌患者提供更高的生存率。

方法

我们搜索了电子数据库 PubMed（自 1996 年起）、Cochrane 对照试验中央登记册（自 1996 年起）和 Scopus（自 2004 年起）至 2021 年 9 月。我们考虑了随机对照试验 (RCT)，比较系统性盆腔和主动脉旁淋巴结清扫术与无晚期 EOC 患者的淋巴结清扫术。主要结局是总生存期和无进展生存期。次要结果是围手术期发病率和手术死亡率。修订后的 Cochrane 随机试验工具（RoB 2 工具）用于纳入研究的偏倚风险评估。我们酌情进行了事件发生时间和标准配对荟萃分析。

结果

我们的审查纳入了两项随机对照试验，共计 1074 名患者。荟萃分析显示相似的总生存期（HR = 1.03，95% CI [0.85-1.24]；低确定性）和无进展生存期（HR = 0.92，95% CI [0.63-1.35]；极低确定性）。关于围手术期发病率，系统性淋巴结清扫术与较高的淋巴水肿和淋巴囊肿形成率相关（RR = 7.31，95% CI [1.89–28.20]；中等确定性）和输血需求（RR = 1.17，95% CI [1.06] –1.29]；中等确定性）。两组之间的其他围手术期不良事件没有观察到统计学上的显着差异。

结论

系统性盆腔和腹主动脉旁淋巴结清扫术可能与晚期 EOC 患者的最佳减瘤患者的总生存期和无进展生存期相似，与无淋巴结清扫术相比。系统性淋巴结清扫术还与某些围手术期不良事件风险增加有关。需要进一步研究我们是否应该在初次减瘤手术期间放弃对完全减瘤患者进行系统性淋巴结清扫术。