Lymphadenectomy in Ovarian Cancer: The Case for Staying in Place

If advanced ovarian cancer has not visibly spread to a patient’s lymph nodes, removing the nodes is not only unnecessary but potentially harmful, researchers report.

Taking out normal-looking lymph nodes in the pelvis or abdomen during complete surgical removal of ovarian cancer did not increase survival, hasten disease progression or improve quality of life. However, removing the lymph nodes — known as lymphadenectomy — did increase postoperative complications, according to Dr. Philipp Harter of Kliniken Essen-Mitte in Germany and colleagues. Their study was published in the New England Journal of Medicine in February 2019.

Although more than half of the patients who underwent lymphadenectomy were later found to have disease that had spread to lymph nodes, excising the nodes did not translate into longer life or time without disease progression, the researchers found.

The authors embarked on the study to help end the debate over whether patients with ovarian cancer should have apparent- ly healthy lymph nodes in the pelvis or abdomen removed to prevent any microscopic disease there from spreading.

Between 2008 and 2012, the trial, Lymphadenectomy in Ovarian Neoplasms (LION), enrolled 647 patients with newly diagnosed stage 2b through 4 ovarian cancer who had no lymph nodes that were enlarged or appeared to the eye, during surgery, to be affected by cancer. Of those women, 323 were randomly assigned to undergo lymph node removal and 324 to forgo it. Those who underwent lymphadenectomy had a median of 57 nodes taken out — 35 pelvic and 22 abdominal.

Median overall survival was similar in both groups — 69.2 months in those who did not have lymph nodes removed and 65.5 months in those who did. The median time from the study’s start until disease progression was 25.5 months in both groups. Pathology findings showed that 55.7% of the women in the lymphadenectomy group had microscopic disease in lymph nodes at the time of surgery.

Serious postoperative complications occurred more frequently in the lymphadenectomy group: A second surgery was performed in 12.4% of those who underwent lymph node removal and 6.5% of those who did not, and the rate of death within 60 days of surgery was 3.1% in the lymphadenectomy group versus 0.9% in the non-lymphadenectomy group. The researchers also found that lymph- adenectomy increased the duration of surgery, amount of blood loss, need for postoperative intensive care, presence of lymph cysts and infection rate. Lymphedema, chronic swelling that results from fluid buildup caused by lymph node removal or other factors such as infection or cancer itself, occurred in 13 patients in the lymphadenectomy group and six in the non-lymphadenectomy group. The researchers found that quality-of-life differences between the two groups were not large enough to be clinically relevant.

“In this trial, patients with advanced ovarian cancer who underwent macroscopically complete resection did not benefit from systematic lymphadenectomy,” they wrote. “In contrast, lymphadenectomy resulted in treatment bur- den and harm to patients.”