Some people with advanced epithelial ovarian cancer may safely avoid having their lymph nodes removed during surgery aimed at removing as much of their primary cancer as possible without it impacting their survival outcomes, helping to reduce the risk of postoperative complications.

The research was presented at the 2024 American Society of Clinical Oncology (ASCO) Annual Meeting, taking place May 31-June 4 in Chicago, Illinois.  

“We already had similar results in patients treated for advanced ovarian cancer with primary surgery followed with adjuvant chemotherapy from the LION trial, which was published in 2019. Today, the more frequent strategy in the case of advanced ovarian cancer is interval surgery, which is surgery after neoadjuvant chemotherapy is given. After the publication of the LION trial, the remaining question was: what is the best strategy for considering the removal of the lymph nodes after neoadjuvant chemotherapy? CARACO helps answer this question for some patients,” said lead study author Jean-Marc Classe, MD, PhD, Institut de Cancerologie de l'Ouest, Nantes University, Nantes, France. 

The phase III CARACO trial enroled 379 people with advanced epithelial ovarian cancer whose lymph nodes did not show signs of cancer before or during surgery to remove their primary cancer.

Between December 2008 and March 2020, participants in the CARACO study were randomly assigned to either undergo a lymphadenectomy (181 participants) or not (187 participants). Most participants (75%) received chemotherapy before their surgery.

Following surgery, most participants in both groups had no signs of cancer remaining, with 88% of those who received a lymphadenectomy showing no signs of disease vs. 86% of those who did not.  

The participants in the lymphadenectomy group had a median of 28 lymph nodes removed during surgery. About half of these participants had cancer in the lymph nodes, with a median of 3 lymph nodes affected. 

Key Findings 

After a median follow-up of 9 years, researchers found that omitting lymphadenectomy did not impact survival outcomes.  

For the participants who did not receive a lymphadenectomy, the progression-free survival was 14.8 months vs. 18.5 months for those who received a lymphadenectomy.  

The median overall survival time was also similar between groups, with half of the participants who did not receive a lymphadenectomy still alive at 48.9 months vs. 58 months for those who did.  

Neither of these results were statistically significant.  

Participants who received a lymphadenectomy experienced more serious complications following surgery than those who did not, including needing additional surgery to manage complications from the initial operation, such as bleeding or fluid build-up (8.3% of participants who received a lymphadenectomy vs. 3.2% of participants who did not), and needing a transfusion (34% vs. 25%, respectively).

However, the percentage of participants who died within 60 days of surgery was relatively similar between groups (1.1% vs. 0.5%, respectively). 

“This randomised phase III clinical trial shows that patients undergoing surgery for advanced ovarian cancer may be able to safely avoid having additional lymph nodes removed that do not appear to be involved with the primary cancer.

While this study’s conclusion does not definitively show a difference between the two groups of patients, this is an important example of surgeons working to decrease the morbidity of surgery without compromising outcomes for people with cancer.

There is still a need for better systemic therapies to improve outcomes in patients with advanced ovarian cancer.” – Michael C. Lowe, MD, MA, Emory University School of Medicine, Atlanta, Georgia.

Next Steps  

The researchers plan to evaluate whether lymphadenectomy is useful for patients with advanced epithelial ovarian cancer who have signs of cancer in the lymph nodes prior to surgery. 

Source: ASCO