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JAMA Surgery Feb 2021Whether sentinel lymph node biopsy (SLNB) can replace lymphadenectomy for surgical staging in patients with high-grade endometrial cancer (EC) is unclear. (Comparative Study)
Comparative Study
IMPORTANCE
Whether sentinel lymph node biopsy (SLNB) can replace lymphadenectomy for surgical staging in patients with high-grade endometrial cancer (EC) is unclear.
OBJECTIVE
To examine the diagnostic accuracy of, performance characteristics of, and morbidity associated with SLNB using indocyanine green in patients with intermediate- and high-grade EC.
DESIGN, SETTING, AND PARTICIPANTS
In this prospective, multicenter cohort study (Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging [SENTOR] study), accrual occurred from July 1, 2015, to June 30, 2019, with early stoppage because of prespecified accuracy criteria. The study included patients with clinical stage I grade 2 endometrioid or high-grade EC scheduled to undergo laparoscopic or robotic hysterectomy with an intent to complete staging at 3 designated cancer centers in Toronto, Ontario, Canada.
EXPOSURES
All patients underwent SLNB followed by lymphadenectomy as the reference standard. Patients with grade 2 endometrioid EC underwent pelvic lymphadenectomy (PLND) alone, and patients with high-grade EC underwent PLND and para-aortic lymphadenectomy (PALND).
MAIN OUTCOMES AND MEASURES
The primary outcome was sensitivity of the SLNB algorithm. Secondary outcomes were additional measures of diagnostic accuracy, sentinel lymph node detection rates, and adverse events.
RESULTS
The study enrolled 156 patients (median age, 65.5 years; range, 40-86 years; median body mass index [calculated as weight in kilograms divided by height in meters squared], 27.5; range, 17.6-49.3), including 126 with high-grade EC. All patients underwent SLNB and PLND, and 101 patients (80%) with high-grade EC also underwent PALND. Sentinel lymph node detection rates were 97.4% per patient (95% CI, 93.6%-99.3%), 87.5% per hemipelvis (95% CI, 83.3%-91.0%), and 77.6% bilaterally (95% CI, 70.2%-83.8%). Of 27 patients (17%) with nodal metastases, 26 patients were correctly identified by the SLNB algorithm, yielding a sensitivity of 96% (95% CI, 81%-100%), a false-negative rate of 4% (95% CI, 0%-19%), and a negative predictive value of 99% (95% CI, 96%-100%). Only 1 patient (0.6%) was misclassified by the SLNB algorithm. Seven of 27 patients with node-positive cancer (26%) were identified outside traditional PLND boundaries or required immunohistochemistry for diagnosis.
CONCLUSIONS AND RELEVANCE
In this prospective cohort study, SLNB had acceptable diagnostic accuracy for patients with high-grade EC at increased risk of nodal metastases and improved the detection of node-positive cases compared with lymphadenectomy. The findings suggest that SLNB is a viable option for the surgical staging of EC.
Topics: Adult; Aged; Aged, 80 and over; Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Middle Aged; Neoplasm Grading; Neoplasm Staging; Predictive Value of Tests; Prospective Studies; Sensitivity and Specificity; Sentinel Lymph Node Biopsy
PubMed: 33175109
DOI: 10.1001/jamasurg.2020.5060 -
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 -
Archives of Gynecology and Obstetrics Jan 2022The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node...
BACKGROUND
The value of pelvic lymphadenectomy (LAE) has been subject of discussions since the 1980s. This is mainly due to the fact that the relation between lymph node involvement of the groin and pelvis is poorly understood and therewith the need for pelvic treatment in general.
PATIENTS AND METHODS
N = 514 patients with primary vulvar squamous cell cancer (VSCC) FIGO stage ≥ IB were treated at the University Medical Center Hamburg-Eppendorf between 1996 and 2018. In this analysis, patients with pelvic LAE (n = 21) were analyzed with regard to prognosis and the relation of groin and pelvic lymph node involvement.
RESULTS
The majority had T1b/T2 tumors (n = 15, 78.9%) with a median diameter of 40 mm (11-110 mm). 17/21 patients showed positive inguinal nodes. Pelvic nodal involvement without groin metastases was not observed. 6/17 node-positive patients with positive groin nodes also had pelvic nodal metastases (35.3%; median number of affected pelvic nodes 2.5 (1-8)). These 6 patients were highly node positive with median 4.5 (2-9) affected groin nodes. With regard to the metastatic spread between groins and pelvis, no contralateral spread was observed. Five recurrences were observed after a median follow-up of 33.5 months. No pelvic recurrences were observed in the pelvic nodal positive group. Patients with pelvic metastasis at first diagnosis had a median progression-free survival of only 9.9 months and overall-survival of 31.1 months.
CONCLUSION
A relevant risk for pelvic nodal involvement only seems to be present in highly node-positive disease, therefore pelvic staging (and radiotherapy) is probably unnecessary in the majority of patients with node-positive VSCC.
Topics: Female; Groin; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Prognosis; Retrospective Studies; Vulvar Neoplasms
PubMed: 34387725
DOI: 10.1007/s00404-021-06156-x -
Journal of Gynecologic Oncology Jan 2024Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in... (Review)
Review
Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer is controversial. Nodal status provides useful prognostic data, and allows to tailor the need of postoperative treatments. However, two independent randomized trials showed that the execution of (pelvic) lymphadenectomy increases the risk of having surgery-related complication without improving patients' outcomes. Sentinel node mapping aims to achieve data regarding nodal status without increasing morbidity. Sentinel node mapping is the removal of first (clinically negative) lymph nodes draining the uterus. Several studies suggested that sentinel node mapping is not inferior to lymphadenectomy in identifying patients with nodal disease. More importantly, thorough ultrastaging sentinel node mapping allows the detection of low volume disease (micrometastases and isolated tumor cells), that are not always detectable via conventional pathological examination. Therefore, the adoption of sentinel node mapping guarantees a higher identification of patients with nodal disease than lymphadenectomy. Further evidence is needed to assess the value of various adjuvant strategies in patients with low volume disease and to tailor those treatments also on the basis of the molecular and genomic characterization of endometrial tumors.
Topics: Female; Humans; Sentinel Lymph Node Biopsy; Sentinel Lymph Node; Lymphatic Metastasis; Neoplasm Staging; Lymph Nodes; Lymph Node Excision; Endometrial Neoplasms
PubMed: 37973163
DOI: 10.3802/jgo.2024.35.e29 -
Journal of B.U.ON. : Official Journal... 2021To investigate the clinical efficacy and safety of laparoscopic pelvic and para-aortic lymphadenectomy in the treatment of endometrial carcinoma.
PURPOSE
To investigate the clinical efficacy and safety of laparoscopic pelvic and para-aortic lymphadenectomy in the treatment of endometrial carcinoma.
METHODS
The clinical data of 110 patients with endometrial carcinoma were retrospectively reviewed. All patients were categorized into two groups. The pelvic lymphadenectomy (PLD) group was subjected to pelvic lymph node dissection alone, while the para-aortic lymphadenectomy (PALD)+PLD group underwent pelvic and para-aortic lymphadenectomy. The operation time, intraoperative bleeding, volume of postoperative drainage, number of resected lymph nodes, number of positive lymph nodes, and incidence of postoperative complications were compared between the two groups of patients. In addition, the tumor recurrence and survival were followed up and compared.
RESULTS
The operation time was significantly longer in the PALD+PLD group than that in the PLD group (p<0.001). The average number of resected lymph nodes and the number of positive lymph nodes in the PALD+PLD group were significantly greater than those in the PLD group. The total recurrence rate was 9.1% (5/55) vs. 20.0% (11/55) between the PLD group and PALD+PLD group, indicating a statistically significant difference (p=0.045). Moreover, the recurrence rate of stage III patients was 50.0% (3/6) and 25.0% (5/55) in the PLD group and PALD+PLD group, respectively, showing a statistically significant difference (p=0.034). During the follow-up period, the 3-year overall survival (OS) was 90.9% (50/55) and 96.4% (53/55) in the PLD group and PALD+PLD group, respectively, indicating no statistically significant difference (p=0.249, log-rank test).
CONCLUSION
Laparoscopic pelvic and para-aortic lymphadenectomy for endometrial carcinoma can increase the number of resected lymph nodes and reduce the recurrence rate. Moreover, it does not increase the incidence rate of surgical complications.
Topics: Endometrial Neoplasms; Female; Humans; Laparoscopy; Lymph Node Excision; Lymph Nodes; Middle Aged
PubMed: 34761585
DOI: No ID Found -
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 -
The Journal of Urology Aug 2023
Topics: Humans; Lymph Node Excision; Lymph Nodes; Radioisotopes; Neoplasm Staging; Sentinel Lymph Node Biopsy
PubMed: 37192376
DOI: 10.1097/JU.0000000000003494 -
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 -
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 -
Medical Archives (Sarajevo, Bosnia and... Aug 2021Lateral pelvic lymph node dissection (LPLD) in rectal cancer has been carried out in several major centers. However, there are still many controversial issues regarding...
BACKGROUND
Lateral pelvic lymph node dissection (LPLD) in rectal cancer has been carried out in several major centers. However, there are still many controversial issues regarding this method such as feasibility, safety, and oncological outcome.
OBJECTIVE
The aim of this study was to evaluate the short-term outcomes, safety, and feasibility of LPLD.
METHODS
This was a retrospective study. A total of 117 patients with lower rectal cancer (clinical stage II/III) below the peritoneal reflection underwent surgery between January 2019 and November 2020 at 108 Military Central Hospital, Hanoi, Vietnam.
RESULTS
Total amount of 25 patients underwent laparoscopic total mesorectal excision (TME) plus LPLD and 92 patients underwent laparoscopic TME without LPLD. The rate of lateral pelvic lymph node metastasis in the LPLD group was 16% (4/25), of which 12% (3/25) were on the left side and 4% (1/25) were on the right side. The rate of intraoperative complications in the LPLD group was significantly higher at 16.0% (4/25) compared with 3.3% (3/92) in the TME only group (p = 0.037). There were no statistically significant differences in the rate of postoperative complications between the two groups (24.0% of patients in the LPLD group compared with 26.1% patients in the no LPLD group, p = 0.832).
CONCLUSION
Pelvic lymphadenectomy has an important role in the treatment of advanced lower rectal cancer. LPLD is a safe and feasible procedure. However, it is necessary to study a larger number of patients with a longer follow-up period to fully evaluate oncological outcomes.
Topics: Asian People; Humans; Laparoscopy; Lymph Node Excision; Rectal Neoplasms; Retrospective Studies; Treatment Outcome
PubMed: 34759451
DOI: 10.5455/medarh.2021.75.297-301