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Cancers Apr 2021use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this... (Review)
Review
BACKGROUND
use of fibrin sealants following pelvic, paraaortic, and inguinal lymphadenectomy may reduce lymphatic morbidity. The aim of this meta-analysis is to evaluate if this finding applies to the axillary lymphadenectomy.
METHODS
randomized trials evaluating the efficacy of fibrin sealants in reducing axillary lymphatic complications were included. Lymphocele, drainage output, surgical-site complications, and hospital stay were considered as outcomes.
RESULTS
twenty-three randomized studies, including patients undergoing axillary lymphadenectomy for breast cancer, melanoma, and Hodgkin's disease, were included. Fibrin sealants did not affect axillary lymphocele incidence nor the surgical site complications. Drainage output, days with drainage, and hospital stay were reduced when fibrin sealants were applied ( < 0.0001, < 0.005, = 0.008).
CONCLUSION
fibrin sealants after axillary dissection reduce the total axillary drainage output, the duration of drainage, and the hospital stay. No effects on the incidence of postoperative lymphocele and surgical site complications rate are found.
PubMed: 33923153
DOI: 10.3390/cancers13092056 -
Medicine Mar 2021To systematically review and evaluate the safety, advantages and clinical application value of laparo-endoscopic single-site surgery (LESS) for endometrial cancer by... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically review and evaluate the safety, advantages and clinical application value of laparo-endoscopic single-site surgery (LESS) for endometrial cancer by comparing it with conventional laparoscopic surgery (CLS).
METHODS
We conducted a systematic review of the published literature comparing LESS with CLS in the treatment of endometrial cancer. English databases including PubMed, Embase, Ovid, and the Cochrane Library and Chinese databases including Chinese National Knowledge Infrastructure, Wanfang and China Biology Medicine were searched for eligible observational studies up to July 10, 2019. We then evaluated the quality of the selected comparative studies before performing a meta-analysis using the RevMan 5.3 software. The complications, surgical time, blood loss during surgery, postoperative length of hospital stay and number of lymph nodes removed during surgery were compared between the 2 surgical approaches.
RESULTS
Four studies with 234 patients were finally included in this meta-analysis. We found that there was no statistically significant difference in complications between the 2 surgical approaches [odds ratio (OR): 0.63, 95% confidence interval (CI): 0.18-2.21, P = .47, I2 = 0%]. There was no statistically significant difference in blood loss between the 2 surgical approaches [mean difference (MD): -61.81, 95% CI: -130.87 to -7.25, P = .08, I2 = 74%]. There was no statistically significant difference in surgical time between the 2 surgical approaches (MD: -11.51, 95% CI: -40.19 to 17.16, P = .43, I2 = 81%). There was also no statistically significant difference in postoperative length of hospital stay between the 2 surgical approaches (MD: -0.56, 95% CI: -1.25 to -0.13, P = .11, I2 = 72%). Both pelvic and paraaortic lymph nodes can be removed with either of the 2 procedures. There were no statistically significant differences in the number of paraaortic lymph nodes and total lymph nodes removed during surgery between the 2 surgical approaches [(MD: -0.11, 95% CI: -3.12 to 2.91, P = .29, I2 = 11%) and (MD: -0.53, 95% CI (-3.22 to 2.16), P = .70, I2 = 83%)]. However, patients treated with LESS had more pelvic lymph nodes removed during surgery than those treated with CLS (MD: 3.33, 95% CI: 1.05-5.62, P = .004, I2 = 32%).
CONCLUSION
Compared with CLS, LESS did not reduce the incidence of complications or shorten postoperative hospital stay. Nor did it increase surgical time or the amount of bleeding during surgery. LESS can remove lymph nodes and ease postoperative pain in the same way as CLS. However, LESS improves cosmesis by leaving a single small scar.
Topics: Blood Loss, Surgical; Endometrial Neoplasms; Female; Humans; Laparoscopy; Length of Stay; Lymph Node Excision; Lymph Nodes; Neoplasm Staging; Operative Time; Pain, Postoperative; Postoperative Complications
PubMed: 33761649
DOI: 10.1097/MD.0000000000024908 -
Urologia Internationalis 2022Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate... (Meta-Analysis)
Meta-Analysis
Clinical Importance of a Peritoneal Interposition Flap to Prevent Symptomatic Lymphoceles after Robot-Assisted Radical Prostatectomy and Pelvic Lymph Node Dissection: A Systematic Review and Meta-Analysis.
BACKGROUND
Robot-assisted radical prostatectomy (RARP) including pelvic lymph node dissection (PLND) is the current state of the art in surgical therapy of localized prostate cancer with intermediate or high risk. PLND in particular is associated with morbidity inherent to this method; the rate of symptomatic lymphoceles (sLCs), for example, ranges up to 10%.
OBJECTIVE
Various intraoperative modifications have been developed with the aim of reducing the sLC rate. Based on current studies, a peritoneal interposition flap (PIF) appears to be one of the most effective methods for this purpose. Under the criteria of a systematic review, 5 retrospective studies have been identified until now, 4 of which showed a positive effect of PIF on the sLC rate.
RESULTS AND LIMITATIONS
A total of 1,308 patients were included in the aggregated analysis of these 5 studies. The amount of sLCs was 1.3% (8/604) and 5.7% (40/704) in the PIF and standard groups, respectively (p < 0.001). The resulting odds ratio (OR) was 0.23 (95% confidence interval [CI]: 0.05-0.99), taking in-to account a noteworthy heterogeneity of the 5 studies (Q = 9.47, p = 0.05; I2 = 58%). In addition, a prospective randomized and blinded study (Pianoforte trial) with corresponding sLC rates of 8.3% (9/108) versus 9.7% (12/124) (p = 0.820) exists. In this study, the OR was 0.85 (95% CI: 0.34-2.10, p = 0.722).
CONCLUSION
Despite positive results from retrospective studies with indirect evidence, the role of the PIF in the reduction of sLC in RARP could not be conclusively assessed yet. The results of the first prospective randomized study do not show a positive effect of PIF, declaring a research gap for further studies with direct evidence.
Topics: Humans; Lymph Node Excision; Lymphocele; Pelvis; Peritoneum; Postoperative Complications; Prostatectomy; Robotic Surgical Procedures; Surgical Flaps
PubMed: 33567440
DOI: 10.1159/000512960 -
Frontiers in Oncology 2020To evaluate the utility of sentinel lymph node mapping (SLN) in endometrial cancer (EC) patients in comparison with lymphadenectomy (LND).
Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis.
OBJECTIVE
To evaluate the utility of sentinel lymph node mapping (SLN) in endometrial cancer (EC) patients in comparison with lymphadenectomy (LND).
METHODS
Comprehensive search was performed in MEDLINE, EMBASE, CENTRAL, OVID, Web of science databases, and three clinical trials registration websites, from the database inception to September 2020. The primary outcomes covered operative outcomes, nodal assessment, and oncological outcomes. Software Revman 5.3 was used. Trial sequential analysis (TSA) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were performed.
RESULTS
Overall, 5,820 EC patients from 15 studies were pooled in the meta-analysis: SLN group (N = 2,152, 37.0%), LND group (N = 3,668, 63.0%). In meta-analysis of blood loss, SLN offered advantage over LND in reducing operation bleeding (I = 74%, P<0.01). Z-curve of blood loss crossed trial sequential monitoring boundaries though did not reach TSA sample size. There was no difference between SLN and LND in intra-operative complications (I = 7%, P = 0.12). SLN was superior to LND in detecting positive pelvic nodes (P-LN) (I = 36%, P<0.001), even in high risk patients (I = 36%, P = 0.001). While no difference was observed in detection of positive para-aortic nodes (PA-LN) (I = 47%, P = 0.76), even in high risk patients (I = 62%, P = 0.34). Analysis showed no difference between two groups in the number of resected pelvic nodes (I = 99%, P = 0.26). SLN was not associated with a statistically significant overall survival (I = 79%, P = 0.94). There was no difference in progression-free survival between SLN and LND (I = 52%, P = 0.31). No difference was observed in recurrence. Based on the GRADE assessment, we considered the quality of current evidence to be moderate for P-LN biopsy, low for items like blood loss, PA-LN positive.
CONCLUSION
The present meta-analysis underlines that SLN is capable of reducing blood loss during operation in regardless of surgical approach with firm evidence from TSA. SLN mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high risk patients with conclusive evidence from TSA. Utility of SLN yields no survival detriment in EC patients.
PubMed: 33520696
DOI: 10.3389/fonc.2020.580128 -
Journal of Gynecologic Oncology Nov 2020To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2-IVA prior to definitive chemoradiotherapy (CRT). (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To evaluate the survival impact of imaging vs surgical nodal assessment in patients with cervical cancer stage IB2-IVA prior to definitive chemoradiotherapy (CRT).
METHODS
PubMed, MEDLINE, Cochrane Library, and ClinicalTrials.gov were used to search for publications in English and Chinese over a 50-year period. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols was used to conduct this review. Inclusion criteria were studies that compared survival outcomes in International Federation of Gynecology and Obstetrics 2009 stage IB2-IVA cervical cancer patients with pre-therapy pelvic and/or aortic lymphadenectomy (LND) or imaging. One or more of the following modalities were used for nodal assessment: computed tomography (CT), magnetic resonance imaging, or positron emission tomography-CT. The National Institutes of Health Quality Assessment Tool was utilized to assess study quality.
RESULTS
The initial search identified 65 studies, and five met the inclusion criteria. There were a total of 1,112 patients. Seven hundred and fifty-four underwent pelvic and/or aortic LND and 358 had imaging. When compared to LND, imaging had a sensitivity and specificity of 88.9% and 22.2% for pelvic lymph node (LN), and 33%-62.5% and 92%-95.5% for para-aortic LN. There were no differences in progression-free survival (PFS) (hazard ratio [HR]=1.13; 95% confidence interval [CI]=0.73-1.74; I²=75%; p<0.01) and overall survival (OS) (HR=1.06; 95% CI=0.66-1.69; I²=75%; p<0.01) between surgical and imaging nodal assessment.
CONCLUSIONS
Imaging and surgical nodal assessment has comparable PFS and OS in patients with cervical cancer stage IB2-IVA.
TRIAL REGISTRATION
PROSPERO Identifier: CRD42020155486.
Topics: Chemoradiotherapy; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Staging; Retrospective Studies; Uterine Cervical Neoplasms
PubMed: 33078589
DOI: 10.3802/jgo.2020.31.e79 -
Journal of Clinical Medicine Aug 2020After the publication of the Lymphadenectomy in Ovarian Neoplasms (LION) trial results, lymphadenectomy in advanced epithelial ovarian cancer with primary complete...
Intraoperative Clinical Examination for Assessing Pelvic and Para-Aortic Lymph Node Involvement in Advanced Epithelial Ovarian Cancer: A Systematic Review and Meta-Analysis.
After the publication of the Lymphadenectomy in Ovarian Neoplasms (LION) trial results, lymphadenectomy in advanced epithelial ovarian cancer with primary complete cytoreductive surgery is considered indicated only for women with suspicious lymph nodes. The aim of this meta-analysis was to evaluate the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery. MEDLINE, EMBASE, Web of Science and the Cochrane Library were searched for January 1990 to May 2019 for studies evaluating the diagnostic accuracy of intraoperative clinical examination for detecting lymph node metastases in patients with advanced epithelial ovarian cancer during primary complete cytoreductive surgery, with histology as the gold standard. Methodological quality was assessed by using the QUADAS-2 tool. Pooled diagnostic accuracy was calculated, and hierarchical summary receiver operating curve was constructed. The potential sources of heterogeneity were analyzed by meta-regression analysis. Deek's funnel plot test for publication bias and Fagan's nomogram for clinical utility were also used. This meta-analysis included five studies involving 723 women. The pooled sensitivity of intraoperative clinical examination for detecting lymph node metastases was 0.79, 95% CI (0.67-0.87), and its specificity 0.85, 95% CI (0.67-0.94); the area under the hierarchical summary receiver operating curve was 0.86, 95% CI (0.83-0.89). In the meta-regression analysis, patient sample size, mean age, and type of cancer included were significant covariates explaining the potential sources of heterogeneity. Deek's funnel plot test showed no evidence of publication bias ( = 0.25). Fagan's nomogram indicated that intraoperative clinical examination increased the post-test probability of lymph node metastases to 79% when it was positive and reduced it to 16% when negative. This meta-analysis shows that the diagnostic accuracy of intraoperative clinical examination during primary complete cytoreductive surgery for detecting lymph node metastases in advanced epithelial ovarian cancer is good.
PubMed: 32872558
DOI: 10.3390/jcm9092793 -
Archivos Espanoles de Urologia Oct 2019ICG navigation in cancer surgery may help during pelvic lymphadenectomy.
OBJECTIVE
ICG navigation in cancer surgery may help during pelvic lymphadenectomy.
METHODS
We performed a systematic review combining the terms: bladder cancer or radical cystectomy and ICG, and prostate cancer or radical prostatectomy and ICG. We used the PRISMA guidelines recommendations. We describe the populations studied in each work, the pathological results, as well as the parameters specificity, sensitivity and predictive values.
RESULTS
In muscle-invasive bladder cancer, 4 case series analyzed the performance of lymphography with ICG. The most accepted injection method is under endoscopic vision. Several punctures are done in the submucosa and the detrusor surrounding the scar. Sentinel nodes were found in up to 92% of patients with a technique sensitivity to find metastases of 88% in the series with largest casuistry. In prostate cancer, we collected data from 11 case series. Nine of them apply transrectal or transperineal dilution immediately before surgery. Sensitivity in the detection of all adenopathies ranged between 44% and 100%. The sensitivity of the technique to know the lymph node stage ranges between 67% and 100%.
CONCLUSIONS
There is little experience of ICG-guided lymph node dissedction in bladder tumors. Endoscopic fluorophore injection allows us to find the nodes that drain the infiltrated area. However, the use of this technique is not widespread. In prostate cancer, it is a reproducible and efficient technique for staging patients with prostate cancer.
Topics: Coloring Agents; Humans; Indocyanine Green; Lymph Node Excision; Lymphatic Metastasis; Lymphography; Male; Pelvis; Prostatic Neoplasms; Sentinel Lymph Node Biopsy; Urinary Bladder Neoplasms
PubMed: 31579042
DOI: No ID Found -
Journal of Clinical Medicine Aug 2019The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial. (Review)
Review
BACKGROUND
The role of lymphonodal dissection during surgery for a tumor of the urinary tract remains controversial.
OBJECTIVE
To analyze anatomical bases of lymphonodal dissection in tumors of the upper urinary tract and analyze its impact on survival, recurrence, and staging. Acquisition of data: A web-based search for scientific articles using Medline/Pubmed was carried out to identify and analyze articles on the practice and the role of lymphonodal dissection in this indication.
DATA SYNTHESIS
The lymphatic drainage of the upper urinary tract has rarely been studied and is poorly understood. The lymphonodal metastatic extension is the most common extension in upper urinary tract urothelial carcinoma. Lymphnode invasion is a clear independent poor prognostic factor. Therefore, it seems legitimate to offer an extended lymphonodal dissection to patients undergoing surgery to cure these tumors. When lymphnodes dissection respects clear anatomical principles based on the location of the primary tumor and its extension, it improves both survival and recurrence rates. This result could be secondary to the treatment of subclinical metastatic disease.
CONCLUSION
An extended lymphadenectomy during surgery for upper urinary tract urothelial carcinoma following strict anatomical pattern improves staging with a highly probable therapeutic benefit.
PubMed: 31398895
DOI: 10.3390/jcm8081190