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• W2531501292 abstract "Over the last 15 years our understanding of the pathogenesis of epithelial ovarian cancer has changed. The most common histopathological subtype, high-grade serous cancer, frequently appears to arise in the distal fallopian tube (Dubeau Lancet Oncol 2008;9:1191–7). Most women present with disease that has spread to the transperitoneal surfaces and to the lymph system. Women with apparent early-stage ovarian cancer have often undergone full surgical staging, including a pelvic and para-aortic lymph node dissection to the level of the renal vessels. This may have been at the time of the original surgery if a frozen section of the ovary is performed or as a second-stage procedure. Approximately 18% women will be upstaged, and this may make the difference between women receiving differing chemotherapy regimes or not receiving chemotherapy at all (Warwick et al. BJOG 2009;116:1225–41). Interestingly, Warwick et al. aimed to define surgical management in apparent early-stage cancer, but made no reference to different histopathological types, although it is likely that the majority of women in the study had high-grade serous disease. In contrast, true primary mucinous ovarian cancer is rare, and often presents within a large mass without apparent distant spread. The mass frequently exhibits benign, borderline and malignant areas. These features combined with similar genetic mutations in these components suggest a transformation pathway from benign to malignant within the ovary (Kurman & Shih Int J Gynecol Pathol 2008;27:151–60). Frozen-section analysis can be difficult because of the large size of the mass and tumour heterogeneity. Given that serous and mucinous cancers have different organs of origin and different pathways of pathogenesis, it is important to ask whether they should still be managed in a similar way. Hoogendam et al. have performed a systematic review and meta-analysis to attempt to answer part of this question. Their paper included data from 11 observational studies and includes 278 women with apparent early primary mucinous cancer of the ovary. Women who underwent lymph-node sampling had positive nodes in 0.7–0.8%, and women who underwent a full nodal dissection had an incidence of 1.2%. Note that meta-analysis involving small observational studies should be interpreted with caution, because of the possibly heterogeneous nature of the studies. For example, in the largest study included in the full-dissection group only 53% of the women underwent both a para-aortic and pelvic node dissection, in contrast with the second largest study in which all underwent a systematic dissection. Furthermore, only one study differentiated between the expansile and potentially more aggressive infiltrative subtypes of mucinous cancer, with three of the latter group having nodal spread. In summary, this meta-analysis suggests that 83 women with apparent early-stage mucinous tumours had to undergo full dissection to detect one women with a positive node(s). Bearing this in mind it is important to note that a nodal dissection is not without risk, including the risk of vascular, nerve, ureteric or bowel injury. Postoperative problems include clinically significant lymphocysts and the long-term risk of debilitating leg lymphoedema. Why does this subject matter? This paper provides further evidence for many centres that no longer support node dissection, or indeed sampling, as part of the staging of mucinous cancer apparently confined to the ovary. The results challenge surgeons that do advocate performing a nodal dissection to publish their data or to consider changing their practice. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article." @default.
• W2531501292 created "2016-10-21" @default.
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• W2531501292 date "2016-10-11" @default.
• W2531501292 modified "2023-10-16" @default.
• W2531501292 title "Evolving surgical practice in mucinous cancer of the ovary" @default.
• W2531501292 doi "https://doi.org/10.1111/1471-0528.14360" @default.
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