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Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta‐analysis
Author(s) -
Hoogendam JP,
Vlek CA,
Witteveen PO,
Verheijen RHM,
Zweemer RP
Publication year - 2017
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/1471-0528.14226
Subject(s) - lymph node , mucinous carcinoma , medicine , ovarian carcinoma , meta analysis , oncology , general surgery , pathology , ovarian cancer , adenocarcinoma , cancer
Background The proportion of women with mucinous ovarian carcinoma in whom nodal metastases are identified during staging remains unclear. Objectives To review the literature on surgical lymph node assessment during staging of women diagnosed with mucinous ovarian carcinoma. Search strategy A systematic search using synonyms of ‘mucinous ovarian carcinoma’ and ‘lymph node assessment’ was conducted in PubMed, Scopus, Embase and the Cochrane Library. Selection criteria When they covered ten or more mucinous ovarian carcinoma cases, staging surgery and minimally one of the following outcomes: prevalence of metastases, stage shift or survival data. Data collection and analysis Studies were quality evaluated with the Cochrane risk‐of‐bias assessment tool for non‐randomised studies of interventions. Outcomes were pooled using an inverse variance weighted random effects model. Main results Sixteen studies were included. In 278 women with mucinous ovarian cancer suspected to be stage I– II , a pooled proportion of 0.8% (95% CI <0.1–2.9%) had lymph node metastases and were upstaged. In those suspected of stage I ( n = 184), this proportion was 0.7% (95% CI <0.1–3.8%). No difference ( P = 0.287) was found in metastases between sampling at 0.0% (95% CI 0.0–3.3%) and complete pelvic and/or para‐aortic lymph node dissection at 1.2% (95% CI <0.1–4.2%). One study directly compared the survival of patients staged with and without lymph node dissection and reported no significant difference. Conclusions Surgical lymph node assessment in women suspected of stage I– II mucinous ovarian carcinoma rarely identifies nodal metastases and consequently has no significant impact on staging. Tweetable abstract Surgical lymph node assessment in women with stage I– II mucinous ovarian cancer rarely has staging consequences.