-
Archives of Gynecology and Obstetrics May 2023Lymphedema is a frequent complication after surgical treatment in gynecological oncology with substantial impact on patients´ Quality of Life (QoL). Little is known...
BACKGROUND
Lymphedema is a frequent complication after surgical treatment in gynecological oncology with substantial impact on patients´ Quality of Life (QoL). Little is known about screening instruments and prevention. Primary objective was to develop and validate the German version of a 13 items screening questionnaire (SQ) developed by Yost et al. to provide a valid instrument for early diagnosis of lower extremity lymphedema (LEL).
METHODS
After translation the SQ was used in pt. with cervical or endometrial cancer who underwent pelvic/paraaortic Lymphadenectomy. Sensitivity and specifity were analysed regarding possible prediction and influencing factors of LEL.
RESULTS
67 pt. had LEL (N = 128). Nearly 50% of women in each group (38 in LEL + e 30 in LEL - ) had a body mass index (BMI) > 30 kg/m. Number of removed lymphnodes, radiotherapy and were significantly associated with development of LEL. Translated Mayo Clinic questionnaire can be used with reliable specifity and sensitivity. Four additional questions improved the diagnostic accuracy of the SQ.
CONCLUSIONS
The translated SQ is a valuable and predictive tool for screening and early detection of LEL in Gynecological cancer surgery and can even improved by adding simple questions.
Topics: Humans; Female; Quality of Life; Lymph Node Excision; Genital Neoplasms, Female; Endometrial Neoplasms; Lymphedema
PubMed: 36222950
DOI: 10.1007/s00404-022-06779-8 -
Urologia Internationalis 2007Radical cystectomy is the standard treatment for muscle invasive bladder cancer, however the role and appropriate extent of an associated lymphadenectomy continues to... (Review)
Review
BACKGROUND
Radical cystectomy is the standard treatment for muscle invasive bladder cancer, however the role and appropriate extent of an associated lymphadenectomy continues to change.
METHODS
We performed a detailed review of the medical literature pertaining to the development and rationale for an extended lymphadenectomy in patients undergoing radical cystectomy.
RESULTS
A perspective of lymphadenectomy and an anatomic account of bladder lymphatic drainage are presented. The technique of an extended lymphadenectomy is also highlighted. Autoptic contemporary clinical data are presented to suggest that a more extensive lymphadenectomy has both prognostic and therapeutic utility. Furthermore, the stage of the primary bladder tumor, total number of lymph nodes removed, and the lymph node tumor burden are shown to be important prognostic variables in patients undergoing cystectomy with pathologic evidence of lymph node metastasis.
CONCLUSIONS
Radical cystectomy provides excellent local cancer control with the Lowe's pelvic recurrence rates and the best long-term survival. Radical cystectomy with an appropriate extended lymphadenectomy, while surgically more challenging, does not significantly increase the morbidity or mortality of the procedure. The limits of lymph node dissection are still subject to debate and there is growing evidence that an extended lymphadenectomy provides further diagnostic and therapeutic benefit.
Topics: Cystectomy; Disease-Free Survival; Humans; Lymph Node Excision; Lymphatic Metastasis; Lymphatic System; Neoplasm Staging; Treatment Outcome; Urinary Bladder Neoplasms
PubMed: 17940349
DOI: 10.1159/000107949 -
JCO Clinical Cancer Informatics Nov 2017To estimate whether pelvic and para-aortic lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer.
PURPOSE
To estimate whether pelvic and para-aortic lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer.
METHODS
We performed matched cohort analyses of women with stage I endometrioid endometrial cancer who underwent hysterectomy with no lymphadenectomy, pelvic lymphadenectomy, or combined pelvic and para-aortic lymphadenectomy. Cox proportional hazards survival analyses were performed with inverse probability weights. Hazard ratios (HRs) were covariate and propensity score adjusted. Covariates included cancer center type, age, race, Hispanic ethnicity, insurance type, community median income quartile, comorbidity score, history of prior cancer, depth of myometrial invasion, tumor grade, tumor size, lymphovascular space invasion, cytology status, surgical margin status, hospital volume, and use of adjuvant radiotherapy or chemotherapy. Additional analyses included subset analyses by grade, sensitivity analyses with imputation of missing data, and testing for sensitivity to possible unmeasured confounding.
RESULTS
Median (interquartile range [IQR]) lymph node counts were 0, 10 (5-15), and 20 (15-27) nodes in the no lymphadenectomy, pelvic, and combined pelvic and para-aortic lymphadenectomy-matched cohorts, respectively. Matched cohorts were well balanced. Two analyses were performed: no lymphadenectomy (n = 7,487) versus pelvic lymphadenectomy (n = 7,487), and pelvic lymphadenectomy (n = 7,060) versus combined pelvic and para-aortic lymphadenectomy (n = 7,060). Performance of pelvic lymphadenectomy was associated with increased survival compared with no lymphadenectomy (5-year survival [95% CI], 91.4% [90.2% to 92.6%] v 87.3% [85.9% to 88.8%]; HR, 0.71 [95% CI, 0.64 to 0.78]; P < .001). Addition of para-aortic lymphadenectomy was associated with increased survival compared with pelvic lymphadenectomy alone (5-year survival [95% CI], 91.0% [89.8% to 92.2%] v 89.8% [88.4% to 91.1%]; HR, 0.85 [95% CI, 0.77 to 0.95]; P = .003). Associations were robust to sensitivity analyses.
CONCLUSION
Lymphadenectomy was associated with increased survival in stage I endometrioid endometrial cancer. An adequately powered randomized trial is needed.
Topics: Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Neoplasm Grading; Neoplasm Staging; Pelvis; Prognosis; Proportional Hazards Models; Retrospective Studies; SEER Program
PubMed: 30657385
DOI: 10.1200/CCI.17.00028 -
Minerva Urology and Nephrology Dec 2022Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus,... (Review)
Review
Prostate cancer and bladder cancer accounts for approximately 13.5% and 3% of all male cancers and all newly diagnosed cancers (regardless sex), respectively. Thus, these cancers represent a major health and economic burden globally. The knowledge of lymph node status is an integral part of the management of any solid tumor. In the urological field, pelvic lymph node dissection (PLND) is of paramount importance in the diagnosis, management, and prognosis of prostate and bladder cancers. However, PLND may be associated with several comorbidities. In this narrative review, the most recent updates concerning the patterns and incidence of lymph node metastasis, the role of different imaging studies and nomograms in determining patients' eligibility for PLND, and the anatomical templates of PLND in urologic patients with bladder or prostate cancer will be discussed.
Topics: Humans; Male; Prostate; Lymph Node Excision; Prostatic Neoplasms; Urinary Bladder Neoplasms; Pelvis
PubMed: 36197698
DOI: 10.23736/S2724-6051.22.04904-7 -
Archivos Espanoles de Urologia Jun 2022To evlauate role of peritoneal re-approximation methods in the prevention of symphtomatic lymphocele formation in patients underwent transperitoneal robot-assisted...
The Results of Peritoneal Re-Approximation Methods on Symptomatic Lymphocele Formation in Robot-Assisted Laparoscopic Radical Prostatectomy and Extended Pelvic Lymphadenectomy.
INTRODUCTION
To evlauate role of peritoneal re-approximation methods in the prevention of symphtomatic lymphocele formation in patients underwent transperitoneal robot-assisted laparoscopic prostatectomy (tRALP) and extendeded pelvic lympadenoctomy (ePLND).
MATERIALS AND METHODS
Between January 2016 and April 2020, 120 consecutive patients who were administered anterior t-RALP and ePLND were analyzed retrospectively. In group 1 (n = 40), peritoneal approximation was not performed after t-RALP and ePLND application, peritoneal half re-approximation was performed in group 2 (n=40), and peritoneal full re-approximation was performed in group 3 (n=40). Operative parameters and symptomatic lymphocele rates were compared between the groups.
RESULTS
There was no statistically significant difference between the groups in terms of mean age, body mass index and prostatespecific antigen levels, Gleason score on biopsy, D'amico risk groups, the mean number of lymph nodes removed, Clavien-Dindo complication grade and mean duration of the surgery. Patients with symptomatic lymphocele in Group 1, Group 2, and Group 3 were found to be 2 (5%), 3 (7.5%) and 5 (12.5%), respectively. There was no statistically significant difference between the groups in terms of symptomatic lymphocele formation.
CONCLUSION
Half or full closure of the peritoneum does not affect the symptomatic lymphocele formation in patients who underwent tRALP and ePLND.
Topics: Humans; Laparoscopy; Lymph Node Excision; Lymphocele; Male; Peritoneum; Prostatectomy; Retrospective Studies; Robotics
PubMed: 35983817
DOI: 10.56434/j.arch.esp.urol.20227505.65 -
BJU International Jun 2017To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of... (Comparative Study)
Comparative Study
Development, validation and clinical application of Pelvic Lymphadenectomy Assessment and Completion Evaluation: intraoperative assessment of lymph node dissection after robot-assisted radical cystectomy for bladder cancer.
OBJECTIVES
To develop a scoring tool, Pelvic Lymphadenectomy Appropriateness and Completion Evaluation (PLACE), to assess the intraoperative completeness and appropriateness of pelvic lymph node dissection (PLND) following robot-assisted radical cystectomy (RARC).
PATIENTS, SUBJECTS AND METHODS
A panel of 11 open and robotic surgeons developed the content and structure of PLACE. The PLND template was divided into three zones. In all, 21 de-identified videos of bilateral robot-assisted PLNDs were assessed by the 11 experts using PLACE to determine inter-rater reliability. Lymph node (LN) clearance was defined as the proportion of cleared LNs from all PLACE zones. We investigated the correlation between LN clearance and LN count. Then, we compared the LN count of 18 prospective PLNDs using PLACE with our retrospective series performed using the extended template (No PLACE).
RESULTS
A significant reliability was achieved for all PLACE zones among the 11 raters for the 21 bilateral PLND videos. The median (interquartile range) for LN clearance was 468 (431-545). There was a significant positive correlation between LN clearance and LN count (R = 0.70, P < 0.01). The PLACE group yielded similar LN counts when compared to the No PLACE group.
CONCLUSIONS
Pelvic Lymphadenectomy Appropriateness and Completion Evaluation is a structured intraoperative scoring system that can be used intraoperatively to measure and quantify PLND for quality control and to facilitate training during RARC.
Topics: Adult; Cystectomy; Humans; Intraoperative Care; Lymph Node Excision; Middle Aged; Patient Outcome Assessment; Pelvis; Prospective Studies; Retrospective Studies; Robotic Surgical Procedures; Urinary Bladder Neoplasms
PubMed: 27987527
DOI: 10.1111/bju.13748 -
International Angiology : a Journal of... Apr 2021The aim of this study was to investigate the effect of maintaining opened distal lymphatic vessels of external iliac lymph nodes on lymphedema and lymphocyst formation... (Observational Study)
Observational Study
BACKGROUND
The aim of this study was to investigate the effect of maintaining opened distal lymphatic vessels of external iliac lymph nodes on lymphedema and lymphocyst formation of lower limbs after pelvic lymphadenectomy.
METHODS
Prospective single center observational study was carried out in 83 patients with gynecological malignancies who underwent pelvic lymphadenectomy. During the operation, the distal lymphatic vessels of the external iliac lymph nodes were cut off by an ultrasound scalpel or scissors, and the proximal end was closed by bipolar coagulation. The patients were re-examined by a physical examination, ultrasound examination and inquiry of the symptoms within 2 years after the operation to check whether they had lower limb lymphedema and to analyze the presence of lymphedema and lymphocyst of lower limbs and the risk.
RESULTS
The incidence of lower limb lymphedema (LLL) was 21.6% (18/83). Among the patients with LLL, 5.5% (1/18) was diagnosed with stage 0 according to the criteria of International Society of Lymphology, 83.3% (15/18) with stage 1, and 11.1% (2/18) with stage 2. Presently, there was no lymphedema diagnosed at stage 3. The incidence of lymphocyst was 7.2% (6/83). Among the patients with lymphocyst, 3.6% (3/83) occurred 1 month after operation, 2.4% (2/83) occurred 3 months after operation and 1.2% (1/83) occurred 6 months after operation. Patients with radiotherapy and abdominal infection were more likely to suffer from LLL (P<0.05).
CONCLUSIONS
Maintaining opened distal lymphatic vessels of external iliac lymph nodes during pelvic lymphadenectomy is feasible, safe and with a 21.6% and 7.2% of potential lymphedema and lymphocists, respectively.
Topics: Humans; Lower Extremity; Lymph Node Excision; Lymph Nodes; Lymphedema; Prospective Studies
PubMed: 33300763
DOI: 10.23736/S0392-9590.20.04486-7 -
The Cochrane Database of Systematic... Sep 2015This is an update of a previous Cochrane review published in Issue 1, 2010. The role of lymphadenectomy in surgical management of endometrial cancer remains... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
This is an update of a previous Cochrane review published in Issue 1, 2010. The role of lymphadenectomy in surgical management of endometrial cancer remains controversial. Lymph node metastases can be found in approximately 10% of women who clinically before surgery have cancer confined to the womb. Removal of all pelvic and para-aortic lymph nodes (lymphadenectomy) at initial surgery has been widely advocated, and pelvic and para-aortic lymphadenectomy remains part of the FIGO (International Federation of Gynaecology and Obstetrics) staging system for endometrial cancer. This recommendation is based on data from studies that suggested improvement in survival following pelvic and para-aortic lymphadenectomy. However, these studies were not randomised controlled trials (RCTs), and treatment of pelvic lymph nodes may not confer a direct therapeutic benefit, other than allocating women to poorer prognosis groups. Furthermore, the Cochrane review and meta-analysis of RCTs of routine adjuvant radiotherapy to treat possible lymph node metastases in women with early-stage endometrial cancer found no survival advantage. Surgical removal of pelvic and para-aortic lymph nodes has serious potential short-term and long-term sequelae. Therefore it is important to investigate the clinical value of this treatment.
OBJECTIVES
To evaluate the effectiveness and safety of lymphadenectomy for the management of endometrial cancer.
SEARCH METHODS
We searched the Cochrane Central Register of Controlled Trials (CENTRAL), the Cochrane Gynaecological Cancer Review Group Trials Register, MEDLINE and EMBASE to June 2009 for the original review and extended the search to June 2015 for this version of the review. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies, and we contacted experts in the field.
SELECTION CRITERIA
RCTs and quasi-RCTs that compared lymphadenectomy versus no lymphadenectomy in adult women diagnosed with endometrial cancer.
DATA COLLECTION AND ANALYSIS
Two review authors independently extracted data and assessed risk of bias. Hazard ratios (HRs) for overall and progression-free survival and risk ratios (RRs) comparing adverse events in women who received lymphadenectomy versus those with no lymphadenectomy were pooled in random-effects meta-analyses. We assessed the quality of the evidence using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach.
MAIN RESULTS
Three RCTs met the inclusion criteria; for one small RCT, data were insufficient for inclusion in the meta-analysis. The two RCTs included in the analysis randomly assigned 1945 women, reported HRs for survival adjusted for prognostic factors and based on 1851 women and had an overall low risk of bias, as they satisfied four of the assessment criteria. The third study had an overall unclear risk of bias, as information provided was not adequate concerning random sequence generation, allocation concealment, blinding or completeness of outcome reporting.Results of the meta-analysis remain unchanged from the previous version of this review and indicate no differences in overall and recurrence-free survival between women who underwent lymphadenectomy and those who did not undergo lymphadenectomy (pooled HR 1.07, 95% CI 0.81 to 1.43; HR 1.23, 95% CI 0.96 to 1.58 for overall and recurrence-free survival, respectively) (1851 participants, two studies; moderate-quality evidence).We found no difference in risk of direct surgical morbidity between women who underwent lymphadenectomy and those who did not undergo lymphadenectomy. However, women who underwent lymphadenectomy had a significantly higher risk of surgery-related systemic morbidity and lymphoedema/lymphocyst formation than those who did not undergo lymphadenectomy (RR 3.72, 95% CI 1.04 to 13.27; RR 8.39, 95% CI 4.06 to 17.33 for risk of surgery-related systemic morbidity and lymphoedema/lymphocyst formation, respectively) (1922 participants, two studies; high-quality evidence).
AUTHORS' CONCLUSIONS
This review found no evidence that lymphadenectomy decreases risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage I disease. Evidence on serious adverse events suggests that women who undergo lymphadenectomy are more likely to experience surgery-related systemic morbidity or lymphoedema/lymphocyst formation. Currently, no RCT evidence shows the impact of lymphadenectomy in women with higher-stage disease and in those at high risk of disease recurrence.
Topics: Adult; Disease-Free Survival; Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Lymphedema; Lymphocele; Quality of Life; Randomized Controlled Trials as Topic
PubMed: 26387863
DOI: 10.1002/14651858.CD007585.pub3 -
TheScientificWorldJournal Mar 2007A pelvic lymph node dissection is commonly performed by urologists in the surgical management of prostate and bladder cancer. Identification of lymph node metastases... (Review)
Review
A pelvic lymph node dissection is commonly performed by urologists in the surgical management of prostate and bladder cancer. Identification of lymph node metastases provides important prognostic information for both diseases. Despite advances in radiographic imaging, a pelvic lymphadenectomy remains the most accurate method to stage lymph node involvement. In the past two decades, there has been an increase in the diagnosis of early stage prostate cancer, which has led some to omit a pelvic lymphadenectomy in patients thought to have low probability of positive lymph nodes. There is little debate, however, over the inclusion of a lymph node dissection in bladder cancer given the approximately 25% incidence of unsuspected nodal disease at the time of surgery. Controversy exists over the extent of an appropriate lymphadenectomy and its therapeutic efficacy. This review will examine the need, extent, and the potential prognostic and therapeutic benefits of a pelvic lymphadenectomy in prostate and bladder cancer.
Topics: Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Male; Practice Guidelines as Topic; Practice Patterns, Physicians'; Prostatic Neoplasms; Sentinel Lymph Node Biopsy; Urinary Bladder Neoplasms
PubMed: 17619762
DOI: 10.1100/tsw.2007.148 -
Current Oncology Reports Aug 2017The aim of this review is to evaluate the trends in multidisciplinary management of localized penile cancer and systemic therapy for advanced disease in the evolving era... (Review)
Review
PURPOSE OF REVIEW
The aim of this review is to evaluate the trends in multidisciplinary management of localized penile cancer and systemic therapy for advanced disease in the evolving era of targeted and immune checkpoint therapy.
RECENT FINDINGS
Organ preservation (surgical or incorporating radiation) and reconstructive techniques are important considerations for quality of life in penile cancer survivors. Although local recurrence may be higher with organ preservation, salvage therapy appears successful. Inguinal and pelvic node management requires multidisciplinary care, including chemotherapy; optimal use of radiation has not been fully defined. Advanced in understanding the biology of penile cancer, particularly with regard to epidermal growth factor receptor (EGFR) and HPV status, have led to clinical trials of targeted and immune therapy for patients with refractory disease. Refinements in the management of penile cancer are occurring, though level 1 evidence remains scarce. Referral to specialized centers will facilitate successful completion of clinical trials to advance standard care in this disease.
Topics: Carcinoma, Squamous Cell; Humans; Lymph Node Excision; Male; Neoplasm Recurrence, Local; Penile Neoplasms; Quality of Life; Plastic Surgery Procedures; Salvage Therapy
PubMed: 28664471
DOI: 10.1007/s11912-017-0615-4