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Zhongguo Yi Xue Ke Xue Yuan Xue Bao.... Jun 2023Bladder cancer is a common malignant tumor of the urinary system.The prognosis of patients with positive lymph nodes is worse than that of patients with negative lymph... (Review)
Review
Bladder cancer is a common malignant tumor of the urinary system.The prognosis of patients with positive lymph nodes is worse than that of patients with negative lymph nodes.An accurate assessment of preoperative lymph node statushelps to make treatmentdecisions,such as the extent of pelvic lymphadenectomy and the use of neoadjuvant chemotherapy.Imaging examination and pathological examination are the primary methods used to assess the lymph node status of bladder cancer patients before surgery.However,these methods have low sensitivity and may lead to inaccuate staging of patients.We reviewed the research progress and made an outlook on the application of clinical diagnosis,imaging techniques,radiomics,and genomics in the preoperative evaluation of lymph node metastasis in bladder cancer patients at different stages.
Topics: Humans; Lymphatic Metastasis; Neoplasm Staging; Cystectomy; Urinary Bladder Neoplasms; Lymph Node Excision; Lymph Nodes
PubMed: 37407535
DOI: 10.3881/j.issn.1000-503X.15333 -
Ginekologia Polska 2020Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomy increases risk of perioperative complications. In clinical...
OBJECTIVES
Retroperitoneal lymph nodes metastases occur frequently in patients with ovarian cancer. Lymphadenectomy increases risk of perioperative complications. In clinical practice to reduce rate of complications aortocaval lymphadenectomy is omitted and solely resection of pelvic lymph nodes is performed. To establish factors affecting metastases to pelvic lymph nodes in advanced ovarian cancer.
MATERIAL AND METHODS
A retrospective study among patients with serous advanced ovarian cancer (FIGO IIIB-IVB) was conducted at the 1st Department of Obstetrics and Gynecology, Medical University of Warsaw and Department of Gynecologic Oncology, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw. All patients underwent surgical treatment including pelvic lymphadenectomy between 2014 and 2017. Data including age, body mass index (BMI), pretreatment CA125 serum level, tumor volume, grading, one-/both-sided tumor, menopausal status, ascites were analysed as possible factors influencing the pelvic lymph nodes involvement. The statistical analysis was performed with Python software.
RESULTS
87 consecutive patients were eligible for the study. Metastases to pelvic lymph nodes were found in 29 (33.33%) patients. Pretreatment serum CA-125 concentration (652 U/mL vs 360.9 U/mL, p < 0.05) and high grade histology corresponded with pelvic nodal involvement.
CONCLUSIONS
The knowledge of factors influencing metastases to pelvic lymph nodes may help clinicians in proper counselling and tailoring of therapy.
Topics: Adult; Aged; Aged, 80 and over; CA-125 Antigen; Cystadenocarcinoma, Serous; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Membrane Proteins; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Ovarian Neoplasms; Pelvis; Retrospective Studies
PubMed: 32141051
DOI: 10.5603/GP.2020.0019 -
Journal of Minimally Invasive Gynecology 2019We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.
STUDY OBJECTIVE
We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions.
DESIGN
Retrospective multi-institution cohort (Canadian Task Force classification II-2).
SETTING
Three tertiary cancer referral cancer centers.
PATIENTS
Patients with endometrial and vulvar cancer undergoing lymph node evaluation.
INTERVENTIONS
Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment.
MEASUREMENTS AND MAIN RESULTS
Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins.
CONCLUSIONS
Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.
Topics: Abdomen; Endometrial Neoplasms; Female; Genital Neoplasms, Female; Gynecologic Surgical Procedures; Humans; Lymph Node Excision; Lymph Nodes; Pelvis; Retrospective Studies; Sentinel Lymph Node; Sentinel Lymph Node Biopsy; Surgeons; Surgical Oncology; Vulvar Neoplasms; Workload
PubMed: 30138740
DOI: 10.1016/j.jmig.2018.08.006 -
Asian Pacific Journal of Cancer... Feb 2022Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of...
BACKGROUND
Performing lymphadenectomy in all patients with early-stage endometrial cancer (EC) is debatable because the procedure may expose patients to unnecessary risks of postoperative complications. Aim of this study was to evaluate the prevalence and risk factors of pelvic lymph node metastasis (PLNM) in patients with apparently early-stage EC.
MATERIALS AND METHODS
Two hundred and two patients with apparently early-stage EC who underwent surgical staging at Thammasat University Hospital between the years 2013 and 2020 were included in this retrospective study. Clinicopathological data and preoperative laboratory results were obtained from computer-based medical records. All data were statistically analyzed to determine the prevalence of PLNM and risk factors for developing PLNM.
RESULTS
PLNM was detected in 22 (10.9%) patients. Univariate analysis demonstrated that having grade 3 tumor, myometrial invasion of 50% or greater, vaginal involvement, cervical involvement, adnexal involvement, lower uterine segment involvement, lymphovascular space invasion (LVSI), and positive peritoneal cytology were associated with higher risk for developing PLNM. In addition, lower preoperative hemoglobin level and higher preoperative white blood cell count were significantly associated with PLNM. Multivariate analysis demonstrated that myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM (odds ratio (OR) 9.31, 95% confidence interval (CI) 2.58-33.55, p = 0.001, and OR 3.73, 95%CI 1.39-10.02, p = 0.009, respectively).
CONCLUSIONS
Myometrial invasion of 50% or greater and LVSI were independent risk factors for developing PLNM in patients with apparently early-stage EC and thus lymphadenectomy in these patients should be provided.
Topics: Adult; Aged; Aged, 80 and over; Early Detection of Cancer; Endometrial Neoplasms; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Middle Aged; Myometrium; Neoplasm Staging; Patient Selection; Pelvis; Predictive Value of Tests; Preoperative Period; Retrospective Studies; Risk Assessment
PubMed: 35225474
DOI: 10.31557/APJCP.2022.23.2.617 -
Ginekologia Polska Oct 2014Ovarian cancer has the highest mortality rate among the female genital malignancies. Its incidence is steadily increasing worldwide, especially in highly industrialized... (Review)
Review
Ovarian cancer has the highest mortality rate among the female genital malignancies. Its incidence is steadily increasing worldwide, especially in highly industrialized countries. Scarce and non-specific clinical symptoms in the early stages, and lack of effective screening methods, are the reasons why in the majority of cases the disease is diagnosed in advanced stage. Early diagnosis and optimal therapeutic method have significant impact on the prognosis. Surgery remains the basic treatment method in all stages of ovarian cancer. The general principle is the removal of the entire tumor or maximal cytoreduction. Pelvic and para-aortic lymphadenectomy is an integral part of the operating protocol. Evaluation of the regional lymph nodes is an important element of the diagnosis in patients with ovarian cancer, as the disease stage and the decision about the method of adjuvant therapy both depend on it. The diagnostic value of lymphadenectomy is unquestionable and is the basis of proper classification, while its therapeutic value remains the subject of controversy. The aim of the paper is to review the results of the most important research concerning lymphadenectomy in ovarian cancer, based on the available literature.
Topics: Carcinoma, Ovarian Epithelial; Female; Humans; Lymph Node Excision; Lymph Nodes; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Women's Health
PubMed: 25546932
DOI: No ID Found -
Journal of Minimally Invasive Gynecology Mar 2024Pelvic lymph node dissection (PLND) is part of the primary treatment for early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer. Pelvic...
Symptomatic Lymphocele After Robot-Assisted Pelvic Lymphadenectomy as Part of the Primary Surgical Treatment for Cervical and Endometrial Cancer: A Retrospective Cohort Study.
STUDY OBJECTIVES
Pelvic lymph node dissection (PLND) is part of the primary treatment for early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer. Pelvic lymphocele is a postoperative complication of PLND, and when symptomatic, lymphoceles necessitate treatment. The aim of this study was to investigate the incidence and risk factors of symptomatic lymphocele after robot-assisted laparoscopic PLND in cervical and endometrial cancer.
DESIGN
Retrospective cohort study.
SETTING
Single-center academic hospital.
PATIENTS
Two hundred and fifty-eight patients with cervical cancer and 129 patients with endometrial cancer.
INTERVENTIONS
Pelvic lymphadenectomy by robot-assisted laparoscopic surgery.
MEASUREMENTS AND MAIN RESULTS
The authors retrospectively included all patients with early-stage cervical cancer and high-intermediate risk or high-risk endometrial cancer who underwent pelvic lymphadenectomy by robot-assisted laparoscopic surgery between 2008 and 2022. Medical records were reviewed for the occurrence of a symptomatic lymphocele. Univariate and multivariate logistic regression analyses were conducted to identify risk factors for developing a symptomatic lymphocele. In total, 387 patients, 258 with cervical cancer and 129 with endometrial cancer, were included in the study. The overall incidence of symptomatic lymphoceles was 9.6% with a median follow-up of 47 months [interquartile range 23-61]. For the entire cohort, smoking was the only significant risk factor for symptomatic lymphoceles identified in univariate (OR 2.47, 95% CI 1.19-5.11) and multivariate analysis (OR 2.42, 95% CI 1.16-5.07). For cervical cancer, body mass index (BMI) (OR 1.09, 95% CI 1.00-1.17) and prior abdominal surgery (OR 2.75, 95% CI 1.22-6.17) were also identified as significant independent risk factors. For endometrial cancer, age was identified as a significant independent risk factor (OR 0.90, 95% CI 0.83-0.97).
CONCLUSION
This single-center cohort study demonstrated an incidence of almost 10% of symptomatic lymphoceles after robot-assisted laparoscopic PLND for cervical cancer and endometrial cancer, with a higher risk observed among patients who smoke at the time of diagnosis. Furthermore, risk factors differ between the 2 populations, necessitating further studies to establish risk models.
Topics: Female; Humans; Retrospective Studies; Lymphocele; Robotics; Uterine Cervical Neoplasms; Cohort Studies; Lymph Node Excision; Endometrial Neoplasms; Pelvis
PubMed: 38171478
DOI: 10.1016/j.jmig.2023.12.010 -
BMC Cancer Dec 2023Up to the present time, there has remained a lack of strong evidence as to whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer....
A multicenter noninferior randomized controlled study of sentinel lymph node biopsy alone versus sentinel lymph node biopsy plus lymphadenectomy for patients with stage I endometrial cancer, INSEC trial concept.
BACKGROUND
Up to the present time, there has remained a lack of strong evidence as to whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer. The traditional surgery for endometrial cancer includes pelvic lymphadenectomy and paraaortic lymph node resection, but complications often seriously affect patients' quality of life. Two randomized controlled trials with large samples have proved that lymphadenectomy does not improve the overall recurrence rate and survival rate of patients. On the contrary, it increases the incidence of complications and even mortality. The current trial is designed to clarify whether sentinel lymph node biopsy can replace lymphadenectomy for early endometrial cancer patients with negative lymph nodes.
METHODS
This study is a randomized, open-label, multicenter and non-inferiority controlled clinical trial in China. Potential participants will be patients with pathologically confirmed endometrial cancer at the Zhejiang Cancer Hospital, Jiaxing Maternity and Child Health Care Hospital, and the First Hospital of Jiaxing in China. The total sample size for this study is 722. Patients will be randomly assigned in a 1:1 ratio to two groups. Patients in one group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy ± paraaortic lymph node resection. Patients in the other group will undergo sentinel lymph node biopsy + total hysterectomy + bilateral salpingo-oophorectomy + pelvic lymphadenectomy ± paraaortic lymph node resection. The 3-year disease-free survival rate, overall survival rate, quality of life (use EORTC QLQ-C30 + QLQ-CX24), and perioperative related indexes of the two groups will be compared.
RESULTS
We expect to find that for patients with early endometrial cancer, the 3-year disease-free survival rate following sentinel lymph node biopsy with indocyanine green combined with near-infrared fluorescence imaging is similar to that following lymphadenectomy. The operation time, as well as incidence of pelvic lymphocyst, lymphedema of lower limb, and edema of vulva in patients who only undergo sentinel lymph node biopsy are expected to be significantly lower than in patients who undergo lymphadenectomy. The quality of life of patients who undergo sentinel lymph node biopsy alone will be significantly better than that of patients who undergo lymph node dissection.
CONCLUSION
This will prove that the prognosis of sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging is not inferior to that of sentinel lymph node biopsy plus lymphadenectomy for early stage endometrial cancer with negative nodal assessment intraoperatively. In addition, sentinel lymph node biopsy alone with indocyanine green combined with near-infrared fluorescence imaging results in fewer surgical complications and gives patients better quality of life.
TRIAL REGISTRATION
chictr.org.cn, ChiCTR1900023161. Registered 14 May 2019, http://www.chictr.org.cn/edit.aspx?pid=38659&htm=4 .
Topics: Pregnancy; Child; Humans; Female; Sentinel Lymph Node Biopsy; Indocyanine Green; Quality of Life; Sentinel Lymph Node; Lymph Node Excision; Lymph Nodes; Endometrial Neoplasms; Randomized Controlled Trials as Topic
PubMed: 38041023
DOI: 10.1186/s12885-023-11226-1 -
World Journal of Urology 1997A good staging system should be able to accurately reflect the natural history of a malignant disease, to express the extent of the disease at the time of diagnosis, and... (Review)
Review
A good staging system should be able to accurately reflect the natural history of a malignant disease, to express the extent of the disease at the time of diagnosis, and stratify patients in prognostically distinctive groups. The staging system for prostate cancer, as it is today, fails to fulfill these requirements. Approximately one third of the patients who undergo surgery for complete excision of prostate cancer in fact do not have a localize disease. The incidence of tumor at the inked margin may reach 30% for T1 stage and up to 60% for clinical T2b prostate cancer according to comparison with pathologic examination of resected specimen. Several concepts have been recently proposed as a means of improving the accuracy of the available staging system. In this paper, we review current aspects of clinical and pathological staging of prostate cancer, and the importance of these new concepts on the early stages of prostate cancer.
Topics: Humans; Lymph Node Excision; Male; Neoplasm Staging; Pelvis; Prostatic Neoplasms; Time Factors
PubMed: 9436284
DOI: 10.1007/BF01300182 -
Scientific Reports Jan 2021After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic... (Clinical Trial)
Clinical Trial
After pelvic lymphadenectomy (PLA), pelvic vessels, nerve, and ureter are skeletonized. Internal hernias beneath the skeletonized pelvic structure following pelvic lymphadenectomy (IBSPP) are a rare complication following PLA. To the best of our knowledge, only 12 IBSPP cases have been reported and clinical details on such hernias remain unknown. The aim of the study was to investigate the incident and etiology of IBSPP. 1313 patients who underwent open or laparoscopic pelvic lymphadenectomy were identified from our database. A retrospective review was performed. Mean follow-up period was 33.9 months. A total of 12 patients had IBSPP. Multivariate analysis of laparoscopic surgeries group as compared to open surgeries group, para-aortic lymphadenectomy rate, number of dissected lymph nodes by PLA, antiadhesive material use rate, and blood loss were lower in laparoscopic surgeries group: odd ratio (OR) = 0.13 [95% confidence interval (CI) 0.08-0.19], and OR = 0.70 [95% CI 0.50-0.99], OR = 0.17 [95% CI 0.10-0.28], OR = 0.93 [95% CI 0.92-0.94]. However, no significant difference was observed in the incidence of IBSPP between laparoscopic surgery (1.0%) and open surgery (0.8%). All IBSPP occurred in the right pelvic space. These findings may contribute to the development of prevention methods for this disease.
Topics: Adult; Female; Follow-Up Studies; Genital Neoplasms, Female; Hernia; Humans; Intestine, Small; Laparoscopy; Lymph Node Excision; Middle Aged; Postoperative Complications; Retrospective Studies
PubMed: 33446912
DOI: 10.1038/s41598-021-81160-4 -
International Journal of Surgery... May 2017According to the International Federation of Gynecology and Obstetrics (FIGO) guidelines, every patient diagnosed with ovarian cancer (OC) should undergo a complete...
BACKGROUND
According to the International Federation of Gynecology and Obstetrics (FIGO) guidelines, every patient diagnosed with ovarian cancer (OC) should undergo a complete staging procedure to adequately assess tumor spread. The role of lymphadenectomy in the initial management of primary early mucinous ovarian cancer (MOC) remains unclear.
OBJECTIVE
To describe the prevalence of pelvic and para-aortic node metastases in MOC.
MATERIALS AND METHODS
The records of patients with MOC treated at our Institute during January 2005 to December 2011 were assessed. A descriptive and comparative analysis was conducted. Overall survival (OS) and diseases-free period (DFP) were calculated with the Kaplan-Meier method and were compared with the log-rank test.
RESULTS
Of 31 patients with MOC, 14 (45.16%) underwent lymphadenectomy, obtaining 190 pelvic nodes, with a median of 9 pelvic lymph nodes removed per patient (interquartile range = 15). There was no evidence of metastatic disease in the dissected pelvic nodes.
CONCLUSION
These results suggest that complete surgical staging with lymph node dissection has no effect on recurrence, disease-free period, and overall survival of patients with early stage MOC.
Topics: Adenocarcinoma, Mucinous; Adult; Aged; Aorta, Thoracic; Carcinoma, Ovarian Epithelial; Disease-Free Survival; Female; Humans; Lymph Node Excision; Lymph Nodes; Lymphatic Metastasis; Mexico; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Neoplasms, Glandular and Epithelial; Ovarian Neoplasms; Pelvis; Retrospective Studies
PubMed: 28315410
DOI: 10.1016/j.ijsu.2017.03.023