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Journal of Clinical Medicine Jul 2023Sentinel node biopsy (SNB) is performed worldwide in patients with endometrial cancer (EC). The aim of this study was to evaluate and compare the occurrence rate of...
Sentinel node biopsy (SNB) is performed worldwide in patients with endometrial cancer (EC). The aim of this study was to evaluate and compare the occurrence rate of lymphatic complications between SNB and pelvic lymphadenectomy (LND) for EC. The medical records of women who underwent SNB or pelvic LND for EC between September 2012 and April 2022 were assessed. A total of 388 patients were enrolled in the current study. Among them, 201 patients underwent SNB and 187 patients underwent pelvic LND. The occurrence rates of lower-extremity lymphedema (LEL) and pelvic lymphocele (PL) were compared between the patients who underwent SNB and those who underwent pelvic LND. The SNB group had a significantly lower occurrence rate of lower-extremity LEL than the pelvic LND group (2.0% vs. 21.3%, < 0.01). There were no patients who had PL in the SNB group; however, 4 (2.1%) patients in the pelvic LND group had PL. The occurrence rates of lower-extremity LEL and PL were significantly lower in patients who underwent SNB than those who underwent pelvic LND. SNB for EC has a lower risk of lymphatic complications compared to systemic LND.
PubMed: 37445574
DOI: 10.3390/jcm12134540 -
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 -
Cancers Nov 2023The role of pelvic lymphadenectomy in endometrial cancer remains unclear. In this study, we aimed to investigate the influence of lymphadenectomy on progression-free and...
The role of pelvic lymphadenectomy in endometrial cancer remains unclear. In this study, we aimed to investigate the influence of lymphadenectomy on progression-free and overall survival among patients diagnosed with endometrial carcinoma. This retrospective single-center study included 1532 patients operated on in a Polish reference center for gynecologic oncology at Holy Cross Hospital, Kielce, between 2002 and 2020. A total of 1004 patients underwent systematic lymphadenectomy as a part of their surgical procedure. The median number of collected lymph nodes was seven. In total, 11.6% of patients were found to have lymph node invasion. The number of lymph nodes removed correlated with patient survival. In patients in whom the number of removed lymph nodes was above the median (>7), the risk of death was reduced (HR 0.68, = 0.002). The risk of death correlated with the presence of lymph node metastasis (HR 4.12, < 0.001). The risk of cancer progression was associated with the number of lymph nodes removed (HR 0.54, = 0.006), and the risk of EC recurrence was greater in patients with lymph node metastasis (HR 1.94, = 0.016). Our study provides additional evidence that systematic lymphadenectomy may influence the disease-free and overall survival of patients with endometrial cancer. The number of lymph nodes removed correlated with patient prognosis. Further studies are needed to evaluate the use of lymphadenectomy in endometrial cancer treatment.
PubMed: 38067339
DOI: 10.3390/cancers15235636 -
PloS One 2022This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic...
OBJECTIVE
This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic features, to recognize patterns of recurrence and to identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS).
DESIGN
This was a single institution, retrospective 10-year review of patients treated at Tygerberg Hospital in South Africa with pathologically confirmed uterine carcinosarcoma.
METHODS
A total of 61 patients were studied. Demographic, clinicopathological, treatment and outcome information were obtained. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the effects of variables on PFS and OS.
RESULTS
Eighteen patients (29%) presented as FIGO stage I disease, 5 patients (8%) as stage II, 16 patients (26%) as stage III and 22 patients (36%) as stage IV disease. Fifty of the 61 patients (82%) had surgery. Five-year PFS and 5-year OS were 17.3% (CI 8.9%-27.9%) and 19.7% (CI 10.6%-30.8%), respectively. Seventeen patients presented with recurrence of which 5 (29.4%) were local and 12 (70.6%) were outside the pelvis. In the univariate analysis, tumour diameter ≥ 100mm (HR 4.57; 95% CI 1.59-13.19; p-value 0.005) was associated with 5-year PFS and in univariate analysis of OS, a positive family history (HR 0.42; 95% CI 0.18-0.99; p-value 0.047), receiving a full staging operation (HR 0.37; 95% CI 0.18-0.78; p-value 0.008) and receiving any other modality of treatment, with or without surgery, (HR 0.48; 95% CI 0.27-0.85; p-value 0.012) were associated with better survival. An abnormal cervical smear (HR 2.4; 95% CI 1.03-5.6; p-value 0.041), late-stage disease (HR 3.48; 95% CI 1.79-6.77; p-value < 0.001), presence of residual tumour (HR 3.66; 95% CI 1.90-7.02; p-value < 0.001), myometrial invasion more than 50% (HR 2.29; 95% CI 1.15-4.57; p-value 0.019), cervical involvement (HR 3.38; 95% CI 1.64-6.97; p-value 0.001) and adnexal involvement (HR 3.21; 95% CI 1.56-6.63; p-value 0.002) were associated with a higher risk of death. In the multivariate analysis, full staging operation was associated with a risk of progression of disease (HR 3.49; 95% CI 1.17-10.41; p-value 0.025). Advanced stage (HR 4.2; 95% CI 2.09-8.44; p-value < 0.001) was associated with a higher risk of death. Any other modality of treatment (HR 0.28; 95% CI 0.15-0.53; p-value < 0.001) and full staging laparotomy (HR 0.27; 95% CI 0.12-0.59; p-value 0.001) was a protective factor for death.
CONCLUSIONS
Carcinosarcoma is an aggressive cancer with poorer survival in this specific cohort than has been described in other contemporary cohorts. Biological or genetic factors are a possible explanation for lower overall survival in this population. Although it is also possible that later diagnosis and poor access to health care contribute to poorer survival. Most recurrences occur outside of the pelvis. Full staging surgery (including pelvic lymphadenectomy) and additional use of other modalities (either for radical or palliative intent) improve survival.
Topics: Carcinosarcoma; Female; Humans; Lymph Node Excision; Neoplasm Staging; Prognosis; Retrospective Studies; Uterine Neoplasms
PubMed: 35862371
DOI: 10.1371/journal.pone.0271526 -
BMJ Open Jun 2023The combination of checkpoint inhibition and cisplatin-based chemotherapy is investigated in muscle invasive bladder cancer (MIBC) and results from phase 2 trials have...
Novel sequential treatment strategy for patients with muscle-invasive bladder cancer (MIBC): intravesical recombinant BCG, followed by neoadjuvant chemoimmunotherapy, radical cystectomy plus pelvic lymphadenectomy and adjuvant immunotherapy - protocol of a multicentre, single arm phase 2 trial...
INTRODUCTION
The combination of checkpoint inhibition and cisplatin-based chemotherapy is investigated in muscle invasive bladder cancer (MIBC) and results from phase 2 trials have been presented. Intravesical BCG has been used for non-MIBC (NMIBC) in patients with carcinoma in situ and high-grade Ta/T1 tumours. BCG induces innate and adapted immune response and upregulation of PD-L1 in preclinical models. The proposed trial is intended to implement a new immuno-immuno-chemotherapy induction therapy for MIBC. The combination of BCG and checkpoint inhibition with chemotherapy aims at higher intravesical responses and better local and systemic control of disease.
METHODS AND ANALYSIS
SAKK 06/19 is an open-label single-arm phase II trial for patients with resectable MIBC T2-T4a cN0-1. Intravesical recombinant BCG (rBCG: VPM1002BC) is applied weekly for three instillations followed by four cycles of neoadjuvant cisplatin/gemcitabine every 3 weeks. Atezolizumab 1200 mg every 3 weeks is started together with rBCG and given for four cycles. All patients then undergo restaging and radical cystectomy and pelvic lymphadenectomy. Atezolizumab is continued as maintenance therapy after surgery every 3 weeks for 13 cycles. Pathological complete remission is the primary endpoint. Secondary endpoints include pathological response rate (
TRIAL REGISTRATION NUMBER
NCT04630730.
Topics: Humans; Cisplatin; BCG Vaccine; Cystectomy; Neoadjuvant Therapy; Urinary Bladder Neoplasms; Immunotherapy; Administration, Intravesical; Muscles; Lymph Node Excision; Multicenter Studies as Topic; Clinical Trials, Phase II as Topic
PubMed: 37286312
DOI: 10.1136/bmjopen-2022-067634 -
Journal of Gynecologic Oncology May 2023The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with... (Review)
Review
BACKGROUND
The Lymphadenectomy in Ovarian Neoplasms (LION) study revealed that systemic lymphadenectomy did not bring survival benefit for advanced ovarian cancer patients with clinically normal lymph nodes and was associated with a higher incidence of operative complications. However, there is no consensus on whether lymphadenectomy has survival benefit or not in early epithelial ovarian cancer (EOC).
METHODS
We designed the LOVE study, a multicenter, randomized controlled, phase III trial to compare the efficacy and safety of comprehensive staging surgery with or without lymphadenectomy in stages IA-IIB EOC and fallopian tube carcinomas (FTC). The hypothesis is that the oncological outcomes provided by comprehensive staging surgery without lymphadenectomy are non-inferior to those of conventional completion staging surgery in early-stage EOC and FTC patients who have indications for post-operative adjuvant chemotherapy. Patients assigned to experimental group will undergo comprehensive staging surgery, but lymphadenectomy. Patients assigned to comparative group will undergo completion staging surgery including systematic pelvic and para-aortic lymphadenectomy. All subjects will receive 3-6 cycles of standard adjuvant chemotherapy. Major inclusion criteria are pathologic confirmed stage IA-IIB EOC or FTC, and patients have indications for adjuvant chemotherapy either confirmed by intraoperative fast frozen section or previous pathology after an incomplete staging surgery. Major exclusion criteria are non-epithelial tumors and low-grade serous carcinoma. Patients with severe rectum involvement which lead to partial rectum resection will be excluded. The sample size is 656 subjects. Primary endpoint is disease-free survival.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04710797.
Topics: Humans; Female; Prospective Studies; Lymphatic Metastasis; Lymph Node Excision; Lymph Nodes; Carcinoma, Ovarian Epithelial; Ovarian Neoplasms; Neoplasm Staging; Randomized Controlled Trials as Topic; Multicenter Studies as Topic; Clinical Trials, Phase III as Topic
PubMed: 37116952
DOI: 10.3802/jgo.2023.34.e52 -
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 -
Journal of the Turkish German... Mar 2022Description and demonstration of the feasibility of laparoscopic management of symptomatic pelvic lymphocele after surgical staging in gynecological cancer surgery....
Description and demonstration of the feasibility of laparoscopic management of symptomatic pelvic lymphocele after surgical staging in gynecological cancer surgery. Step-by-step description of the surgical procedure using pictures and an educational video. Patient gave informed consent for the use of images and the full video article was approved by the Institutional Review Board of the Hospital of Sant Pau. Lymphocele is one of the most common complications of pelvic or lumbo-aortic lymphadenectomy. Although the incidence is variable at 1-58%, around 5-18% of cases are symptomatic. Only symptomatic lymphocele requires treatment, which can be medical or interventional. Drainage is usuallyperformed by guided radiology although a surgical approach has shown a lower rate of recurrence. A 64-years-old woman diagnosed withendometrial carcinosarcoma was staged laparoscopically by pelvic and para-aortic lymphadenectomy. Para-aortic lymphadenectomy wasperformed using an extraperitoneal approach. Three weeks later she presented with an intense and persistent burning pain, radiating towardsthe left leg. Computed tomography imaging suggested the presence of a 10x7.6 cm lymphocele adjacent to the left external iliac vessels.Laparoscopy was performed with four-port placement configuration, enabling the identification of a large, bilobed lymphocele, adjacent to theleft pelvic wall and left paracolic gutter. Adhesiolysis and identification of main landmarks in the left paracolic gutter and left paravesical fossawas performed as a first step. Peritoneum of each lymphocele was opened in the caudal region and the opening was broadened to facilitatelymph drainage. Owing to the low morbidity and excellent results, we suggest that laparoscopic drainage should be performed as a feasible anduseful treatment for pelvic symptomatic lymphoceles.
PubMed: 34109774
DOI: 10.4274/jtgga.galenos.2021.2021.0028 -
Journal of the Turkish German... Mar 2020Pelvic lymph node dissection is one of the leading surgical procedures in gynecologic oncology practice. Learning the proper technique with anatomic landmarks will...
Pelvic lymph node dissection is one of the leading surgical procedures in gynecologic oncology practice. Learning the proper technique with anatomic landmarks will improve surgical skills and confidence. This video demonstrates a right-side systematic pelvic lymphadenectomy in a cadaveric model.
PubMed: 30905139
DOI: 10.4274/jtgga.galenos.2019.2018.0167 -
Surgery Journal (New York, N.Y.) Dec 2021Radical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and...
Radical hysterectomy (RH) is a standard treatment for early-stage cervical cancer. This surgery extirpates the uterus along with the paracervical tissues, vagina, and the paracolpium to achieve local control. Pelvic lymphadenectomy is a critical component of RH performed for regional control. A clear understanding of pelvic anatomy is critical to safely performing a RH and achieving optimal oncological and functional outcomes. The various surgical steps can damage the pelvic autonomic nerves, and a systematic nerve-sparing technique is used for the preservation of autonomic nerves. There is an intricate vascular network in the lateral paracervix (cardinal ligament) and the pelvic sidewall. We need to comprehend the three-dimensional structure of the vascular and nerve anatomy in the pelvis to perform RH effectively and safely. We can create six spaces around the uterine cervix, including the paravesical spaces, pararectal spaces, a vesicovaginal space, and a rectovaginal space to reveal the target of extirpation. It is critical to find the proper tissue plane separated by the layers of membranous connective tissue (fascia), in order to minimize intraoperative bleeding.
PubMed: 35111930
DOI: 10.1055/s-0041-1739119