Introduction:
Ovarian cancer is the seventh most common cancer in women worldwide (1).
It accounts for 5% of cancer-related female deaths, primarily due to
late diagnosis. Approximately, 51% of patients are diagnosed at stage
III and 29% at stage IV, which yields 5‐year cause‐specific survival of
42% and 26%, respectively (2). In 2018, 295,414 patients were newly
diagnosed with ovarian cancer and 184,799 died of the disease worldwide
(3).
Standard treatment of ovarian cancer is primary debulking surgery,
aiming to achieve complete resection of macroscopic disease, followed by
platinum/taxane-based chemotherapy (4). A residual tumor less than 1 cm
after completion of surgery is considered “optimal debulking” (5).
Society of Gynecologic Oncology and American Society of Clinical
Oncology clinical practice guideline recommend that all women with
suspected stage IIIC or IV epithelial ovarian cancer receive neoadjuvant
chemotherapy if optimal debulking is unlikely with primary surgery (6).
Whether systematic lymphadenectomy (sysLA) should be considered a
routine part of debulking surgery has been controversial. Lymphatic
spread is commonly encountered even in early stages of ovarian cancer.
Lymph node (LN) metastasis is reported in 6.5% and 40.7% of women with
stage I and stage II disease, respectively (7). However, several studies
failed to disclose significant impact of sysLA on overall survival of
ovarian cancer, including a recent clinical trial on 647 patients with
stage IIB to IV disease (8-10). Surgical morbidity associated with sysLA
should be weighed by clear evidence of survival benefit, if any, to
consider sysLA as a part of surgical debulking (11). In this review, our
objective is to appraise clinical outcomes of sysLA in women with
ovarian cancer and to determine prognostic value of sysLA in relation to
disease stage and treatment approach.