Evaluation of cytoreductive surgery with pelvic and paraaortic lymphadenectomy and intermittent cisplatin-based combination chemotherapy for improvement of long-term survival in ovarian cancer.

The present study was designed in order to assess the therapeutic values of pelvic and paraaortic lymphadenectomy in cytoreductive surgery and intermittent systematic chemotherapy combining cisplatin, doxorubicin, and cyclophosphamide, namely, intermittent PAC for improvement of the long-term prognosis of patients with epithelial ovarian cancer. Intermittent PAC was administered every 3 months over a period of approximately 2 years. One hundred and fifty-five patients with epithelial ovarian cancer were enrolled in the study. The estimated 10-year survival rate of 42 patients with stage I or II ovarian cancer who received pelvic and paraaortic lymphadenectomy and the intermittent PAC was significantly higher than that of 31 patients with the same stages who did not (83.9% vs. 61.1%, p<0.05). Similarly, the estimated 10-year survival rate of 38 patients with stage III or IV ovarian cancer who underwent the above-mentioned treatments was significantly high compared with that of 44 patients in the same advanced stages who did not (60.4% vs. 25.0%, p<0.01). As for pelvic and paraaortic lymphadenectomy, there was no significant difference in the estimated 10-year survival rates between patients with and without retroperitoneal lymph node metastasis. Multivariate analysis revealed that the performance of pelvic and paraaortic lymphadenectomy was the most important factor leading successful clinical remission of the advanced ovarian cancers. Cytoreductive surgery including pelvic and paraaortic lymphadenectomy and to intermittent PAC were thus suggested to be capable of dramatically improving the long-term survival even in advanced epithelial ovarian cancers.