Removing lymph nodes after chemotherapy can improve survival of ovarian cancer patients: AIIMS study

In India, ovarian cases are increasing day by day and almost one lakh cases are detected every year. It has emerged as the third most common cancer among women after breast and cervical cancer, doctors said.

New Delhi: Removal of the lymph nodes from the pelvis and rear abdominal walls can significantly improve the survival chances of ovarian cancer patients, found a study conducted by AIIMS, Delhi.

The study was published in the Journal of the Egyptian National Cancer Institute on April 11.

The probability of overall survival at five years in 105 patients who were included in the study was found to be 48.9 per cent.

Dr M D Ray, professor in the department of surgical oncology at Dr B R Ambedkar Institute Rotary Cancer Hospital (Dr BRA-IRCH), AIIMS and the principal investigator of the study, said, "We found that the removal of lymph nodes from pelvis and rear abdominal walls in a systematic manner can significantly improve the patient's survival."

"This is a challenging procedure as the main vessels related to the heart are all around lymph nodes and so surgeons need to be specially trained for this technique," Dr Ray said.

These involved enlarged lymph nodes are an integral part of ovarian cancer and, therefore, they should be removed even after chemotherapy, he said.

In India, ovarian cases are increasing day by day and almost one lakh cases are detected every year. It has emerged as the third most common cancer among women after breast and cervical cancer, Dr Ray said.

Between 2012 and 2018, 255 ovarian cases were operated at IRCH, out of which 105 advanced ovarian cancers were analysed as part of the study.

Dr Ray said these 105 patients with advanced ovarian cancer had undergone pelvic and retroperitoneal lymph node dissection.

Various studies demonstrated that chemotherapy does not sterilise the involved nodes and thereby these positive nodes become the potential sites for relapse, i.e., lymph nodes act as a 'safe-haven'.

"Nodal involvement post-chemotherapy, therefore, could be a harbinger or may be an indicator of the aggressiveness of the disease," the study said.

The study has also proposed Nodal Cancer Index (NCI) so that surgeons could remove the lymph nodes in better objective manners in turn leading to better survival outcomes in Ovarian cancer patients.

The study mentioned that the incidence of ovarian cancer is rapidly increasing along with breast cancer and it is considered the most lethal gynaecological cancer worldwide.

More than two-thirds of the cases are present in advanced stages, i.e., FIGO IIIC onwards. Around the globe, optimal cytoreductive surgery (CRS) followed by systemic chemotherapy is the standard of care for advanced ovarian cancers.

In recent times, intraperitoneal chemotherapy has added an essential armamentarium in managing such advanced cases, although optimal cytoreduction is the most prognostic factor, the study said.

According to the present concept, CRS includes removing all macroscopic residual disease but the routine removal of pelvic and retroperitoneal lymph nodes is not an integral part of cytoreduction in the standard of care, it stated.