Surgical lymph node assessment in mucinous ovarian carcinoma staging: a systematic review and meta-analysis

Abstract

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.

Keywords: Lymph node metastases; mucinous ovarian carcinoma; staging.