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Journal of Gynecologic Oncology Mar 2021This review aims to introduce preoperative scoring systems to predict lymph node metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role of... (Review)
Review
OBJECTIVES
This review aims to introduce preoperative scoring systems to predict lymph node metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role of lymphadenectomy for endometrial cancer.
METHODS
We summarized previous reports on the preoperative prediction models for LNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, we compared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) to examine the survival benefit of lymphadenectomy in endometrial cancer, and described the details of JCOG1412.
RESULTS
Lymphadenectomy has been omitted for 64 endometrial cancer patients who met low-risk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphatic failure has been observed. Other two models also produced comparable results. Two randomized phase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrial cancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aortic lymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients at risk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, including lower limit of the number of resected nodes, and submission of photos of dissected area to evaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showed that the quality of lymphadenectomy has been well-controlled in JCOG1412.
CONCLUSION
Our strategy seems reasonable to omit lymphadenectomy and could be generalized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms of the quality of surgical procedures, which would draw the bona-fide conclusions regarding the therapeutic role of lymphadenectomy for endometrial cancer.
Topics: Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Pelvis
PubMed: 33470067
DOI: 10.3802/jgo.2021.32.e25 -
Clinical & Experimental Metastasis Aug 2018Sentinel lymph node (SLN) based pelvic lymph node dissection (PLND) in prostate cancer (PCa) is appealing over the time, cost and morbidity classically attributed to... (Review)
Review
Sentinel lymph node (SLN) based pelvic lymph node dissection (PLND) in prostate cancer (PCa) is appealing over the time, cost and morbidity classically attributed to conventional PLND during radical prostatectomy. The initial report of feasibility of the SLN concept in prostate cancer was nearly 20 years ago. However, PLND based on the SLN concept, either SLN biopsy of a single node or targeted SLN dissection of multiple nodes, is still considered investigational in PCa. To better appreciate the challenges, and potential solutions, associated with SLN-based PLND in PCa, this review will discuss the rationale behind PLND in PCa and evaluate current SLN efforts in the most commonly diagnosed malignancy in men in the US.
Topics: Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Pelvis; Prostate; Prostatectomy; Prostatic Neoplasms; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 30187286
DOI: 10.1007/s10585-018-9936-4 -
Journal of Surgical Oncology Dec 2015Robotic-assisted laparoscopy is now the most common surgical method for treatment of early-stage endometrial, cervical, and a growing number of ovarian cancers in the... (Review)
Review
Robotic-assisted laparoscopy is now the most common surgical method for treatment of early-stage endometrial, cervical, and a growing number of ovarian cancers in the U.S. Para-aortic and pelvic lymphadenectomy is integral to surgical staging and subsequent treatment planning. This article reviews current staging outcomes with robotic surgery for gynecologic cancers, and describes both trans-peritoneal, extra-peritoneal aortic dissection techniques, and the integration of pelvic sentinel lymph node mapping.
Topics: Aorta; Conversion to Open Surgery; Female; Florida; Genital Neoplasms, Female; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Neoplasm Staging; Ovarian Neoplasms; Pelvis; Peritoneum; Robotic Surgical Procedures; Uterine Cervical Neoplasms; Uterine Neoplasms
PubMed: 26288990
DOI: 10.1002/jso.24005 -
Ceska Gynekologie 2016Overview of classification, anatomical conditions, methods and complications of pelvic and paraaortic lymph-node dissection. (Review)
Review
OBJECTIVE
Overview of classification, anatomical conditions, methods and complications of pelvic and paraaortic lymph-node dissection.
DESIGN
Review article.
SETTING
Department of Obstetrics and Gynecology, General Faculty Hospital and 1st Medical Faculty, Charles University, Prague.
MATERIALS AND METHODS
Lymphadenectomy is classified according to its extent into sentinel lymph-node biopsy, debulking, sampling and systematic procedure and according to approach into extraperitoneal or transperitoneal procedure. The most complex variant is systematic pelvic and paraaortic lymph-node dissection, which requires removal of fatty-lymphatic tissue from anatomically strictly defined areas. Procedure can be performed from laparotomy, laparoscopically or robotically.
RESULTS
The main objective criterium of systematic procedure is the number of harvested nodes. The most common complications comprise bleeding and lymphocele formation.
CONCLUSIONS
Pelvic and paraaortic lymphadenectomy represent basic component of surgical management in majority of gynecological cancers. The knowledge of extent, different techniques and ability to solve complications represents essential skill in gynecological oncology.
Topics: Aorta, Abdominal; Female; Genital Neoplasms, Female; Humans; Lymph Node Excision; Pelvis
PubMed: 27882746
DOI: No ID Found -
Best Practice & Research. Clinical... Nov 2017Robotic-assisted laparoscopic surgery is the most common approach for the treatment of early-stage endometrial and cervical cancers in the US. Surgical staging requires... (Review)
Review
Robotic-assisted laparoscopic surgery is the most common approach for the treatment of early-stage endometrial and cervical cancers in the US. Surgical staging requires pelvic and often aortic lymphadenectomy, depending on the primary tumor characteristics. Pelvic and aortic lymphadenectomy procedures may also be indicated for debulking of larger metastases to improve disease control. The infra-renal basin is an important anatomic site of metastasis from pelvic tumors, and robotic dissection techniques for this site have been described. In recent years, sentinel lymph node (SLN) mapping has been adopted into the National Comprehensive Cancer Network guidelines' surgical algorithm for uterine and cervical cancers. SLN mapping has higher sensitivity for the detection of nodal metastasis, despite removing fewer lymph nodes, and potentially reduces morbidities such as lower extremity lymphedema. This article reviews current robotic pelvic and para-aortic lymphadenectomy dissection techniques for endometrial and cervical cancers and discusses the recent integration of pelvic SLN mapping in the surgical algorithm.
Topics: Female; Genital Neoplasms, Female; Humans; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Neoplasm Staging; Pelvis; Robotic Surgical Procedures; Sentinel Lymph Node; Sentinel Lymph Node Biopsy
PubMed: 28533155
DOI: 10.1016/j.bpobgyn.2017.04.006 -
Bulletin Du Cancer Dec 2021The evolution of knowledge in gynecologic oncology is leading to surgical de-escalation in several areas, particularly in lymph node staging. Sentinel lymph node biopsy... (Review)
Review
The evolution of knowledge in gynecologic oncology is leading to surgical de-escalation in several areas, particularly in lymph node staging. Sentinel lymph node biopsy that was initially used in low and intermediate risk endometrial cancer, has now been extended to high-intermediate and high-risk endometrial cancer. Sentinel lymph node biopsy plays also an important role in the nodal staging of early-stage cervical cancer. The radicality of hysterectomies in patients with early cervical cancer is under debate. Similarly, surgical staging with para-aortic lymphadenectomy in locally advanced cervical cancer should be performed only for few cases. Systematic pelvic and para-aortic lymphadenectomy in patients with advanced ovarian cancers is not recommended anymore.
Topics: Chemoradiotherapy; Conservative Treatment; Endometrial Neoplasms; Female; Fertility Preservation; Humans; Hysterectomy; Lymph Node Excision; Neoplasm Staging; Ovarian Neoplasms; Pelvis; Sentinel Lymph Node Biopsy; Uterine Cervical Neoplasms
PubMed: 34629168
DOI: 10.1016/j.bulcan.2021.06.012 -
Urologic Oncology Mar 2019Lymph node dissection is part of the standard treatment protocol for various cancers, but its role in prostate cancer has been debatable for some time. Pelvic... (Review)
Review
Lymph node dissection is part of the standard treatment protocol for various cancers, but its role in prostate cancer has been debatable for some time. Pelvic lymphadenectomy has been shown to better help stage prostate cancer patients, but has yet to be definitively proven to be of any benefit for survival. Various templates for lymph node dissections exist, and though some national guidelines have endorsed an extended pelvic node dissection, the choice of template is still controversial. Pelvic lymphadenectomy may lead to a slightly higher rate complications and operative time, and their use must be judiciously applied to patients with a high enough risk of lymph node involvement. We present a comprehensive review of the literature regarding the benefits and harms of lymph node dissection in prostate cancer.
Topics: Disease-Free Survival; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Neoplasm Staging; Operative Time; Patient Selection; Pelvis; Postoperative Complications; Practice Guidelines as Topic; Prostatectomy; Prostatic Neoplasms; Survival Analysis
PubMed: 30579787
DOI: 10.1016/j.urolonc.2018.11.020 -
Journal of Laparoendoscopic & Advanced... Jul 2022To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of...
To evaluate the impact of body mass index (BMI), preoperative risk classification, previous inguinal herniotomy, and abdominal operations on several steps of robot-assisted radical prostatectomy (RARP) and lymph node (LN) involvement. A total number of 225 consecutive patients were included in the study who underwent transperitoneal RARP by 1 surgeon. We defined the following parameters as dependent variables: duration of prostatectomy, duration of pelvic lymphadenectomy, incision to suture time, console time, number of dissected LNs and number of positive LNs for metastasis. We assessed the impact of the following covariates using univariate nonparametric and multivariate analysis: BMI, preoperative D'Amico risk classification, history of inguinal herniotomy, and previous abdominal operations. We observed a statistically significant difference among our three BMI groups (<25, ≥25 and <30, and ≥30 kg/m) regarding pelvic lymphadenectomy and LN metastasis. Moreover, among the three risk groups (low, intermediate, and high) duration of prostatectomy, pelvic lymphadenectomy, and LN metastasis were statistically different. Previous abdominal operations have been also demonstrated to significantly influence the pelvic lymphadenectomy. In addition, our multivariate model proved the impact of our covariates on pelvic lymphadenectomy. Our findings highlight the impact of BMI and preoperative risk on various steps of RARP. We revealed longer duration of pelvic lymphadenectomy and more nodal yield in patients with higher BMI and high-risk disease. Therefore, we suggest that BMI and risk classification according to D'Amico should be taken into account while a RARP is being planned.
Topics: Humans; Laparoscopy; Lymph Node Excision; Lymphatic Metastasis; Male; Pelvis; Prostatectomy; Retrospective Studies; Robotic Surgical Procedures; Robotics
PubMed: 34962160
DOI: 10.1089/lap.2021.0520 -
Journal of Surgical Oncology Jun 2023Lateral pelvic lymph node (LPLN) involvement occurs in 10%-25% of rectal cancer cases. Total mesorectal excision (TME) with routine LPLN dissection (LPLND) is... (Review)
Review
Lateral pelvic lymph node (LPLN) involvement occurs in 10%-25% of rectal cancer cases. Total mesorectal excision (TME) with routine LPLN dissection (LPLND) is predominantly applied in Japan whereas TME with neoadjuvant treatment are used in the West. LPLND is a morbid procedure and minimally invasive techniques may help reduce its morbidity. Selective lateral pelvic node dissection with TME following neoadjuvant treatment achieves acceptable disease-free and overall survival.
Topics: Humans; Dissection; Japan; Lymph Node Excision; Lymph Nodes; Rectal Neoplasms; Pelvis
PubMed: 37222691
DOI: 10.1002/jso.27317 -
Current Opinion in Urology Jul 2023Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with... (Review)
Review
PURPOSE OF REVIEW
Bilateral pelvic lymph node dissection (PLND) at the time of radical cystectomy (RC) provides important staging information and oncologic benefit in patients with bladder cancer. The optimal extent of the PLND remains controversial. Our aim is to highlight nodal mapping studies and the data that guides optimization of both staging and oncologic outcomes. We then review contemporary randomized trials studying the extent of PLND.
RECENT FINDINGS
A recent randomized trial (RCT) powered for a 15% improvement in recurrence-free survival (RFS) of extended (e) over limited (l)PLND was completed but failed to identify this large difference in outcome. Concerns over study design limit the ability to interpret the oncologic results. Importantly, ePLND minimally changed surgical morbidity. An ongoing, similar RCT (SWOG S1011) powered to detect a 10% difference in RFS has completed accrual, but no published outcomes are available.
SUMMARY
RC and ePLND can provide cure in 33% of LN positive bladder cancer patients. Current data support a 5% improvement in RFS if ePLND is routinely used in MIBC patients. Two randomized trials powered to identify much larger (15 and 10%) improvements in RFS are unlikely to identify such an ambitious benefit by extending the PLND.
Topics: Humans; Pelvis; Urinary Bladder Neoplasms; Lymph Node Excision; Urinary Bladder; Cystectomy; Muscles; Lymph Nodes
PubMed: 37021936
DOI: 10.1097/MOU.0000000000001096