Lymphadenectomy During Staging Laparotomy in Early-Stage Ovarian Cancer: a Critical Analysis of Retrospective Data

Comprehensive pelvic and para-aortic lymphadenectomy (CLD) is traditionally considered essential for accurate staging of early-stage epithelial ovarian cancer (ESOC). However, its impact on survival outcomes compared to limited nodal sampling (LNS) during staging laparotomy remains uncertain, particularly in the context of adjuvant chemotherapy. This retrospective study included patients with histologically confirmed ESOC who underwent staging laparotomy between January 2017 and December 2021. Patients with borderline, benign, germ cell, or metastatic tumours were excluded. PFS and OS were analysed using Kaplan-Meier and log-rank tests. Hazard ratios (HR) were calculated using Cox regression. A total of 144 patients were included in our study: 117 underwent LNS and 27 underwent CLD. High-grade serous ovarian carcinoma (HGSOC) accounted for 70% of cases. All patients with HGSOC received adjuvant chemotherapy. After a median follow-up of 45 months, no statistically significant difference in PFS (p = 0.5) or OS (p = 0.7) was observed between groups. Mean OS was 83.3 months (LNS) vs. 86.7 months (CLD). HRs for PFS and OS across all histologies were 0.94 and 0.95, respectively. In the HGSOC subgroup, OS HR was lower at 0.63, suggesting a potential trend toward improved survival with CLD. However, CLD was associated with higher postoperative morbidity, including lymphocyst formation and lymphedema. Limited nodal sampling did not compromise survival outcomes in patients with ESOC, including HGSOC. In the context of universal adjuvant chemotherapy, LNS may be an acceptable alternative to CLD in select patients. Prospective trials are warranted to validate these findings.