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.