Tuesday, March 19, 2019
NEJM Study Shows No Long-Term Benefit from Removal of Normal Appearing Lymph Nodes
In the Lion study (Lymphadenectomy in Ovarian Neoplasms), 647 women with advanced ovarian cancer - as defined by the International Federation of Gynecology and Obstetrics as Stage IIB to IV - were randomly assigned to either receive or not receive complete pelvic and paraaortic removal of lymph nodes.
What makes this study interesting is the inclusion criteria. All women had to have no residual disease after a complete resection and all women had to have normal appearing lymph nodes. The nodes had to be viewed directly and not simply palpated. In addition, the centers involved in the study had to be evaluated for surgical quality.
Previously normal appearing pelvic and paraaortic lymph nodes have been seen as hiding places for metastatic cancer cells and treatment protocols called for the removal of these lymph nodes. Recurrences showed in second-look surgeries, that these lymph nodes contained cancer cells that had not been successfully treated with initial chemo, prompting some researchers to call these lymph nodes "pharmacological sanctuaries".
However, as many women have attested to, there are complications associated with the removal of these nodes from having to wear thigh-high compression stockings (try wearing those in the summer) to outright lymphedema. Women who had lymph node resection also had higher rates of post-op complications within 60 days of surgery including death.
Ultimately, the median over all survival rate in women without lymph node removal was 69.4 months vs 65.5 months among women with lymph node removal. Median progression-free survival in both groups was the same at 25.5 months.
To read the extract of this study, follow this link.