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Cancers
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Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy
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Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (31 December 2023) | Viewed by 17092

Special Issue Editors

Dr. Juan Jose Segura-Sampedro

E-Mail Website
Guest Editor
1. General & Digestive Surgery Department, Hospital Universitario Son Espases, 07120 Palma de Mallorca, Spain
2. School of Medicine, University of the Balearic Islands, 07120 Palma de Mallorca, Spain
3. Health Research Institute of the Balearic Islands (IdISBa), 07120 Palma de Mallorca, Spain
Interests: peritoneal carcinomatosis; HIPEC; EPIC; PIPAC; intraperitoneal chemotherapy; hyperthermia; peritoneal metastases; cytoreductive surgery; Sugarbaker’s procedure
Special Issues, Collections and Topics in MDPI journals
Dr. Pedro Antonio Cascales-Campos

E-Mail Website
Guest Editor
1. Departament of Oncologic Surgery, Hospital Clínico Universitario Virgen de la Arrixaca, CP 30150 Murcia, Spain
2. Instituto Murciano de Investigación Biosanitaria (IMIB-Arrixaca), CP 30150 Murcia, Spain
Interests: HIPEC; peritoneal carcinomatosis; colorectal cancer; ovarian cancer; liver transplant

Special Issue Information

Dear Colleagues,

Peritoneal carcinomatosis used to be a lethal condition regardless of its origin (gastrointestinal cancer, gynaecologic cancer or peritoneal mesothelioma). This has changed radically in the last several years. Today we know that peritoneal metastases can be prevented and even treated with curative intention. Although there have been promising results, there is still a lack of standardization regarding the multiple different HIPEC regimens used and the different techniques to administrate this intraperitoneal chemotherapy, with new options such as PIPAC and different indications. There are some aspects which are unclear, such as how to better identify who benefits the most from this multimodal treatment of cytoreductive surgery, intraperitoneal chemotherapy and perioperatory chemotherapy. We are in need of new evidence in order to improve our treatment protocols and the radiologic identification and categorization of disease and patients. We also know that there might be patients with high risk of developing peritoneal metastases. We need to identify these patients in order to select those who would benefit from a proactive oncoprophylactic treatment.

This Special Issue aims to summarize the current state of the art on the biology, diagnosis, selection, treatment and outcomes of peritoneal carcinomatosis, with special attention to perioperative intraperitoneal chemotherapy and future trends in the research and clinical management of this entity.

Potential topics include, but are not limited to:

  • Current and new cytostatic agents;
  • Morbidity and morbility associated with cytoreductive surgery and HIPEC;
  • Indications and new trends in PIPAC;
  • Indications and new trends in EPIC;
  • Diagnosis and selection of patients for cytoreductive surgery;
  • Immunomediated effects of cytoreductive surgery and HIPEC;
  • Role of cytoreductive surgery and HIPEC in ovarian cancer;
  • Role of HIPEC in rare diseases;
  • Role of cytoreductive surgery and HIPEC in colorectal cancer.

Dr. Juan Jose Segura-Sampedro
Dr. Pedro Antonio Cascales-Campos
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • peritoneal carcinomatosis
  • HIPEC
  • EPIC
  • PIPAC
  • intraperitoneal chemotherapy
  • hyperthermia
  • peritoneal metastases
  • cytoreductive surgery
  • Sugarbaker’s procedure

Related Special Issue

Published Papers (10 papers)

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Editorial

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2 pages, 176 KiB  
Editorial
Standardizing Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer Treatment: Navigating Complexities and Charting the Path Forward
by Juan José Segura-Sampedro and Pedro Cascales-Campos
Cancers 2024, 16(2), 400; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16020400 - 17 Jan 2024
Viewed by 697
Abstract
The incorporation of hyperthermic intraperitoneal chemotherapy (HIPEC) into the treatment landscape for ovarian cancer has invoked a spectrum of emotions, ranging from enthusiastic anticipation to cautious skepticism [...] Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)

Research

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17 pages, 4024 KiB  
Article
Prognostic Significance of Preoperative Inflammation Markers on the Long-Term Outcomes in Peritoneal Carcinomatosis from Ovarian Cancer
by Irina Balescu, Mihai Eftimie, Sorin Petrea, Camelia Diaconu, Bogdan Gaspar, Lucian Pop, Valentin Varlas, Adrian Hasegan, Cristina Martac, Ciprian Bolca, Marilena Stoian, Cezar Stroescu, Anca Zgura and Nicolae Bacalbasa
Cancers 2024, 16(2), 254; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16020254 - 05 Jan 2024
Viewed by 861
Abstract
Ovarian cancer remains one of the most lethal gynaecological malignancies affecting women worldwide; therefore, attention has been focused on identifying new prognostic factors which might help the clinician to select cases who could benefit most from surgery versus cases in which neoadjuvant systemic [...] Read more.
Ovarian cancer remains one of the most lethal gynaecological malignancies affecting women worldwide; therefore, attention has been focused on identifying new prognostic factors which might help the clinician to select cases who could benefit most from surgery versus cases in which neoadjuvant systemic therapy followed by interval debulking surgery should be performed. The aim of the current paper is to identify whether preoperative inflammation could serve as a prognostic factor for advanced-stage ovarian cancer. Material and methods: The data of 57 patients who underwent to surgery for advanced-stage ovarian cancer between 2014 and 2020 at the Cantacuzino Clinical Hospital were retrospectively reviewed. The receiver operating characteristic curve was used to determine the optimal cut-off value of different inflammatory markers for the overall survival analysis. The analysed parameters were the preoperative level of CA125, monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), neutrophil-to-lymphocyte ratio (NLR) and systemic inflammation index (SII). Results: Baseline CA125 > 780 µ/mL, NLR ≥ 2.7, MLR > 0.25, PLR > 200 and a systemic immune inflammation index (SII, defined as platelet × neutrophil–lymphocyte ratio) ≥ 84,1000 were associated with significantly worse disease-free and overall survival in a univariate analysis. In a multivariate analysis, MLR and SII were significantly associated with higher values of overall survival (p < 0.0001 and p = 0.0124); meanwhile, preoperative values of CA125, PLR and MLR were not associated with the overall survival values (p = 0.5612, p = 0.6137 and p = 0.1982, respectively). In conclusion, patients presenting higher levels of MLR and SII preoperatively are expected to have a poorer outcome even if complete debulking surgery is performed and should be instead considered candidates for neoadjuvant systemic therapy followed by interval surgery. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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18 pages, 3783 KiB  
Article
Neoadjuvant Chemotherapy plus Interval Cytoreductive Surgery with or without Hyperthermic Intraperitoneal Chemotherapy (NIHIPEC) in the Treatment of Advanced Ovarian Cancer: A Multicentric Propensity Score Study
by Antoni Llueca, Maria Victoria Ibañez, Pedro Cascales, Antonio Gil-Moreno, Vicente Bebia, Jordi Ponce, Sergi Fernandez, Alvaro Arjona-Sanchez, Juan Carlos Muruzabal, Nadia Veiga, Berta Diaz-Feijoo, Cristina Celada, Juan Gilabert-Estelles, Cristina Aghababyan, Javier Lacueva, Alicia Calero, Juan Jose Segura, Karina Maiocchi, Sara Llorca, Alvaro Villarin, Maria Teresa Climent, Katty Delgado, Anna Serra, Luis Gomez-Quiles, Maria Llueca and on behalf of Spain GOG and GECOP Working Groupadd Show full author list remove Hide full author list
Cancers 2023, 15(17), 4271; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15174271 - 26 Aug 2023
Cited by 2 | Viewed by 1210
Abstract
Introduction: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor [...] Read more.
Introduction: Epithelial ovarian cancer (EOC) is primarily confined to the peritoneal cavity. When primary complete surgery is not possible, neoadjuvant chemotherapy (NACT) is provided; however, the peritoneum-plasma barrier hinders the drug effect. The intraperitoneal administration of chemotherapy could eliminate residual microscopic peritoneal tumor cells and increase this effect by hyperthermia. Intraperitoneal hyperthermic chemotherapy (HIPEC) after interval cytoreductive surgery could improve outcomes in terms of disease-free survival (DFS) and overall survival (OS). Materials and Methods: A multicenter, retrospective observational study of advanced EOC patients who underwent interval cytoreductive surgery alone (CRSnoH) or interval cytoreductive surgery plus HIPEC (CRSH) was carried out in Spain between 07/2012 and 12/2021. A total of 515 patients were selected. Progression-free survival (PFS) and OS analyses were performed. The series of patients who underwent CRSH or CRSnoH was balanced regarding the risk factors using a statistical analysis technique called propensity score matching. Results: A total of 170 patients were included in each subgroup. The complete surgery rate was similar in both groups (79.4% vs. 84.7%). The median PFS times were 16 and 13 months in the CRSH and CRSnoH groups, respectively (Hazard ratio (HR) 0.74; 95% CI, 0.58–0.94; p = 0.031). The median OS times were 56 and 50 months in the CRSH and CRSnoH groups, respectively (HR, 0.88; 95% CI, 0.64–1.20; p = 0.44). There was no increase in complications in the CRSH group. Conclusion: The addition of HIPEC after interval cytoreductive surgery is safe and increases DFS in advanced EOC patients. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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9 pages, 266 KiB  
Article
HIPEC in Ovarian Cancer Is the Future… and Always Will Be? Results from a Spanish Multicentric Survey
by Alida González Gil, Álvaro Cerezuela Fernández-de Palencia, Álvaro Jesús Gómez Ruiz, Elena Gil Gómez, Francisco López Hernández, Aníbal Nieto Ruiz, Jerónimo Martínez, Iván Marhuenda and Pedro Antonio Cascales Campos
Cancers 2023, 15(13), 3481; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15133481 - 04 Jul 2023
Cited by 3 | Viewed by 1376
Abstract
Ovarian cancer is the leading cause of death due to gynecological tumors in the female population. Despite optimal first-line treatment, including cytoreduction and platinum-based systemic chemotherapy, recurrences are frequent. The use of hyperthermic intraperitoneal chemotherapy (HIPEC) has been criticized, especially because of the [...] Read more.
Ovarian cancer is the leading cause of death due to gynecological tumors in the female population. Despite optimal first-line treatment, including cytoreduction and platinum-based systemic chemotherapy, recurrences are frequent. The use of hyperthermic intraperitoneal chemotherapy (HIPEC) has been criticized, especially because of the lack of randomized controlled trials (RCTs) with convincing results to support the use of HIPEC in patients with ovarian cancer with peritoneal dissemination. In 2018, the clinical trial published by Van Driel et al. reported improved outcomes in favor of HIPEC treatment with cisplatin. In this study, we conducted a national survey within the Spanish group of peritoneal surgical oncology (Grupo Español de Cirugía Oncológica Peritoneal, GECOP) to explore the impact of the results of this RCT on clinical practice. A total of 33 groups completed the survey. Routine clinical practice was not changed in 28 of the 33 groups (85%) based on the results of the Van Driel trial. Despite the results of this RCT, most groups considered that more RCTs are needed and that, in the future, HIPEC may become the standard of care. In conclusion, the results from RCTs evaluating HIPEC treatment in patients with ovarian cancer has not been transferred to clinical practice. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
12 pages, 2142 KiB  
Article
Intraperitoneal BromAc® Does Not Interfere with the Healing of Colon Anastomosis
by Ahmed H. Mekkawy, Mohammad Breakeit, Krishna Pillai, Samina Badar, Javed Akhter, Sarah J. Valle and David L. Morris
Cancers 2023, 15(13), 3321; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15133321 - 24 Jun 2023
Cited by 1 | Viewed by 921
Abstract
A combination of bromelain and acetylcysteine, BromAc®, is an efficient intraperitoneal mucolytic for thick mucus secreted in pseudomyxoma peritonei (PMP). Patients with PMP quite often undergo colon anastomosis. Hence, we investigated the effect of the intraperitoneal delivery of BromAc® on [...] Read more.
A combination of bromelain and acetylcysteine, BromAc®, is an efficient intraperitoneal mucolytic for thick mucus secreted in pseudomyxoma peritonei (PMP). Patients with PMP quite often undergo colon anastomosis. Hence, we investigated the effect of the intraperitoneal delivery of BromAc® on colon-anastomosis healing in a rat model. Sixteen Wistar rats were divided into two groups (N = 8). The controls received intraperitoneal saline after anastomosis, whilst the other group received BromAc®. They were monitored for body-weight and general health parameters. Half the rats in each group (N = 4) were culled at 4 or 13 days post-surgery for assessment. The healing process of the tissues was assessed by burst pressure and collagen density with histology to assess the integrity of the internal organs. The results indicated that there was a similar pattern of weight fluctuation during the experiment, although the rats treated with the BromAc® showed slightly greater weight loss during the first 4 days. Although the burst pressure was similar in both groups, the BromAc® group at day 13 showed a slightly higher burst pressure, which was complemented by a higher collagen density (albeit not statistically significant). The histology of the internal organs was comparable to those of the controls. This study indicates that the intraperitoneal delivery of BromAc® in a rat model does not interfere with the healing process of colonic anastomosis. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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17 pages, 1286 KiB  
Article
Role of HIPEC after Complete Cytoreductive Surgery (CRS) in Peritoneal Recurrence of Platinum-Sensitive Recurrent Ovarian Cancer (OC): The Aim for Standardization at Two Reference Centers for CRS
by Miklos Acs, Michael Gerken, Vanessa Schmitt, Pompiliu Piso, Alfred Königsrainer, Saher Baransi, Can Yurttas, Sebastian Häusler and Philipp Horvath
Cancers 2023, 15(2), 405; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15020405 - 07 Jan 2023
Cited by 1 | Viewed by 2519
Abstract
Background: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. Methods: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a [...] Read more.
Background: This bicentric study evaluated cytoreductive surgery (CRS) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for platinum-sensitive recurrent ovarian cancer patients. Methods: The data of 88 patients with the first peritoneal recurrence of platinum-sensitive epithelial ovarian cancer who underwent CRS and HIPEC from a prospective HIPEC registry were retrospectively investigated. Endpoints were feasibility, chemotherapeutic compound, time of exposure, complications, and overall survival. Results: The median follow-up was 4.7 years (95%-CI 4.6–5.5). The median age was 55.8 years (IQR: 50.3–66.2). Eighty-four patients (95.5%) had high-grade serous histology. The median peritoneal cancer index was 12.0 (IQR: 7.0–20.5). Sixty-five patients (73.9%) had complete cytoreduction (CCR 0). Thirty-eight patients (43.2%) received HIPEC for 60 min, and fifty patients (56.8%) for 90 min. Eighteen patients (20.5%) had grade III to IV complications. One patient (1.1%) died perioperatively. The overall median survival was 43.1 months (95%-CI 34.1–52.2), and the 5-year survival rate was 39.7%. Only 90 min HIPEC and cisplatin were associated with survival. Conclusion: In well-selected patients with platinum-sensitive recurrent ovarian cancer, survival may correlate with complete CRS and 90 min cisplatin-based HIPEC. We confirmed the results of primary OC studies; therefore, this combination should be used for further analysis in the recurrent situation. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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18 pages, 1654 KiB  
Article
Prolonged Exposition with Hyperthermic Intraperitoneal Chemotherapy (HIPEC) May Provide Survival Benefit after Cytoreductive Surgery (CRS) in Advanced Primary Epithelial Ovarian, Fallopian Tube, and Primary Peritoneal Cancer
by Miklos Acs, Zoltan Herold, Attila Marcell Szasz, Max Mayr, Sebastian Häusler and Pompiliu Piso
Cancers 2022, 14(14), 3301; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers14143301 - 06 Jul 2022
Cited by 5 | Viewed by 1661
Abstract
Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, [...] Read more.
Background: The usage of cytoreductive surgery combined with hyperthermic intraperitoneal chemotherapy (HIPEC) for advanced gynecological cancers is increasing. Methods: Prospectively collected data of 85 advanced primary ovarian/fallopian tube cancer and peritoneal carcinoma patients of a single center were investigated. Results: A total 48, 37, 62, and 25 patients were enrolled into the HIPEC with/without neoadjuvant chemotherapy (upfront vs. interval) and into the 60 min and 90 min long HIPEC groups, respectively. Better overall survival (OS) was observed in the 90 min HIPEC group (p = 0.0330), compared to the 60 min HIPEC group. Neither OS (p = 0. 2410), disease-specific (p = 0. 3670), nor recurrence-free survival (p = 0.8240) differed between upfront and interval HIPEC. Higher peritoneal carcinomatosis index (PCI) values were associated with worse disease-specific survival (p = 0.0724). Age (p = 0.0416), body mass index (p = 0.0044), PCI (p < 0.0001), the type (p = 0.0016) and duration (p = 0.0012) of HIPEC, and increased perioperative morbidity (p < 0.0041) had the greatest impact on OS. Conclusions: Increasing data support the value of HIPEC in the treatment of advanced ovarian cancer. Ongoing prospective studies will definitively clarify the role and timing of this additional therapeutic approach. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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Review

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24 pages, 1529 KiB  
Review
Appendiceal Mucinous Neoplasms: From Clinic to Pathology and Prognosis
by Luis González Bayón, Lorena Martín Román and Pablo Lozano Lominchar
Cancers 2023, 15(13), 3426; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15133426 - 30 Jun 2023
Cited by 1 | Viewed by 2624
Abstract
Appendiceal mucinous neoplasms have been classified differently over time causing confusion when comparing results between working groups in this field and establishing a prognosis of the disease. A historical perspective of the different classification systems of these tumors is essential for the understanding [...] Read more.
Appendiceal mucinous neoplasms have been classified differently over time causing confusion when comparing results between working groups in this field and establishing a prognosis of the disease. A historical perspective of the different classification systems of these tumors is essential for the understanding of the evolution of concepts and histopathological definitions that have led up to the present moment. We carried out a systematic review of the pathological classifications of appendiceal mucinous tumors and how they have included the new criteria resulting from clinical and pathological research. The latest classifications by PSOGI and AJCC 8th edition Cancer Staging have made a great effort to incorporate the new pathological descriptions and develop prognostic groups. The introduction of these new classification systems has posed the challenge of verifying how they adapt to our casuistry and which one defines best the prognosis of our patients. We reclassified our series of patients treated for mucinous appendiceal tumors with cytoreductive surgery and hyperthermic intraperitoneal chemotherapy following the PSOGI and the AJCC 8th edition criteria and concluded that both classifications correspond well with the OS and DFS of these patients, with some advantage relative to the PSOGI classification due to a better histopathological description of the different groups. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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11 pages, 429 KiB  
Review
Gastric Cancer with Peritoneal Metastases: Current Status and Prospects for Treatment
by Israel Manzanedo, Fernando Pereira, Estíbalitz Pérez-Viejo and Ángel Serrano
Cancers 2023, 15(6), 1777; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers15061777 - 15 Mar 2023
Cited by 5 | Viewed by 2970
Abstract
Gastric cancer (GC) has a poor prognostic and only one in four patients will have survived by 5 years after diagnosis. These poor results are due to the fact that most patients are diagnosed in advanced stages; peritoneal metastases (PM) are especially frequent [...] Read more.
Gastric cancer (GC) has a poor prognostic and only one in four patients will have survived by 5 years after diagnosis. These poor results are due to the fact that most patients are diagnosed in advanced stages; peritoneal metastases (PM) are especially frequent and are difficult to treat. Currently, PM are considered a terminal stage of GC with a poor survival rate and are treated with palliative systemic chemotherapy. Since the beginning of the century, the treatment of PM from different origins has evolved; cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have become the treatment of choice for many malignant diseases that affect the peritoneum. CRS and HIPEC have also been used for patients with GC and PM, achieving survival results that have never been achieved when using systemic chemotherapy alone. The use of HIPEC can even prevent the development of peritoneal recurrences in patients with locally advanced GC as adjuvant therapy, can reduce the volume of peritoneal disease as neoadjuvant therapy, and can control symptoms in a palliative setting. The aim of this review is to collate the current scientific evidence regarding the treatment of PM of GC origin with surgery and intraperitoneal chemotherapy. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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Other

13 pages, 2047 KiB  
Systematic Review
The Role of Systematic Lymphadenectomy in Low-Grade Serous Ovarian Cancer: A Systematic Review and Meta-Analysis
by Rosa Montero-Macías, Juan José Segura-Sampedro, Pascal Rigolet, Fabrice Lecuru, Andrea Craus-Miguel and Juan Manuel Castillo-Tuñón
Cancers 2024, 16(5), 955; https://0-doi-org.brum.beds.ac.uk/10.3390/cancers16050955 - 27 Feb 2024
Viewed by 774
Abstract
Objective: To evaluate the role of systematic lymphadenectomy in low-grade serous ovarian cancer (LGSOC) and determine its impact on clinical outcomes in overall survival (OS) and disease-free survival (DFS) terms. Methods: A comprehensive, systematic computer literature search on PubMed was performed using the [...] Read more.
Objective: To evaluate the role of systematic lymphadenectomy in low-grade serous ovarian cancer (LGSOC) and determine its impact on clinical outcomes in overall survival (OS) and disease-free survival (DFS) terms. Methods: A comprehensive, systematic computer literature search on PubMed was performed using the following Medical Subject Headings (MeSH) terms: “low grade serous ovarian cancer” AND/OR “lymphadenectomy” AND/OR “staging” AND/OR “ovarian cancer” AND/OR “cytoreduction”. Separate searches were performed with MeSH terms on MEDLINE and EMBASE to extract all the relevant literature available. We included only patients with histologically confirmed LGSOC. Results: Three studies were considered in the quantitative analysis. Systematic lymphadenectomy in LGSOC failed to provide a significant OS or PFS benefit in LGSOC when compared to no lymphadenectomy in the entire (all the stages) population (for OS: HR = 1.15, 95% CI [0.42, 3.18] I2 = 84% and for PFS: HR = 1.46, 95% CI [0.63, 3.41], I2 = 71%), nor did it in the subtype analysis regarding FIGO stages. For FIGO early-stage I-II LGSOC, the DFS data were pooled (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%). In patients with advanced-stage (FIGO II–IV), we also failed to prove survival benefit for lymphadenectomy in OS (HR = 1.74, 95% CI [0.87, 3.48], I2 = 11%) or DFS (HR = 1.48, 95% CI [0.58, 3.78], I2 = 75%) compared to no lymphadenectomy. Conclusion: More extensive prospective research is mandatory to understand the real impact of lymphadenectomy on survival in LGSOC. The existing literature does not provide strong evidence. Full article
(This article belongs to the Special Issue Advances in Cytoreductive Surgery and Intraperitoneal Chemotherapy)
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