Management of endometrial cancer: Issues and controversies (original) (raw)
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Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: Current evidence
Journal of Obstetrics and Gynaecology Research, 2014
The aim of the present review is to summarize the current evidence on the role of pelvic and para-aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation-related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended.
Hel J Obst Gynecol, 2017
Endometrial cancer represents a common malignancy of the female reproductive system and systematic surgical staging is the primary therapeutic approach, as offers many advantages in diagnosis, treatment and prognosis. Pelvic and para-aortic lymphadenectomy remains an integral part of the primary surgical therapeutic approach of endometrial cancer and provides substantial information concerning the need of postoperative adjuvant treatment, in order to improve survival, minimize side-effects and toxicity from over-treatment and avoid issues related to under-treatment. However, the extend of pelvic and para-aortic lymphadenectomy, has a direct correlation with the incidence of perioperative complications. Sentinel lymph node mapping and dissection constitutes a compromise between systematic and no lymphadenectomy especially in low or intermediate risk patients with endometrial cancer. It is a very popular and attractive approach in this patient subgroup and minimizes the incidence of perioperative complications compared to systematic lymphadenectomy. In conclusion, sentinel lymph node mapping and dissection still remains an experimental approach in patients with endometrial cancer, but it could possibly have a more important role in the assessment of pelvic and para-aortic lymph nodes and finally substitute systematic lymphadenectomy in the near future.
Lymphadenectomy for the management of endometrial cancer
2009
Background This is an update of a previous Cochrane review published in Issue 1, 2010 and updated in Issue 9, 2015. The role of lymphadenectomy in surgical management of endometrial cancer remains controversial. Lymph node metastases can be found in approximately 10% of women who before surgery are thought to 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), MEDLINE and Embase to June 2009 for the original review, updated the search to June 2015 for the last updated version and further extended the search to March 2017 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. Lymphadenectomy for the management of endometrial cancer (Review)
The Role of Lymphadenectomy in Surgical Staging of Endometrial Cancer
International Journal of Surgical Oncology, 2011
Surgical staging, including lymph node sampling, for endometrial cancer was adopted by the International Federation of Gynecology and Obstetrics (FIGO) in 1988 based on reports demonstrating diagnostic and therapeutic advantages. This review focuses on the incidence of lymph node metastasis, risk factors for lymph node involvement, the effect of lymph node metastasis on prognosis, the therapeutic effect and diagnostic usefulness of lymphadenectomy, risks of lymph node dissection, and future directions in surgical staging of endometrial cancer. Surgical staging identifies most patients with extrauterine disease as well as uterine risk factors for recurrence, thereby allowing for a more informed approach to postoperative adjuvant therapy. Lymphadenectomy as a part of surgical staging is not required in patients assessed intraoperatively to be at low risk for lymph node metastasis (<2 cm grade 1 tumors with superficial myometrial invasion), however, a systematic lymph node dissectio...
Journal of Gynecologic Surgery, 2010
Objective: Pelvic lymph nodes are the most common site of extrauterine spread in clinical early-stage endometrial cancer. International Federation of Gynecology and Obstetrics has mandated surgical evaluation of lymph nodes in endometrial cancer since 1988; however, the clinical impact of lymphadenectomy has never been addressed. Design: We reported a retrospective analysis in order to evaluate whether pelvic systematic lymph dissection improves overall and progression-free survival compared with no lymphadenectomy. Method: From 1991 through 2008, patients with endometrial carcinoma were evaluated using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. Results: Of the 410 patients with a diagnosis of endometrial carcinoma, 390 underwent primary surgery. Of those who underwent surgery, 285 had endometrioid histology. One hundred and ninety (190) patients had surgery with no lymphadenectomy, whereas 95 had surgery with lymphadenectomy. Only 4 women revealed positive nodes. Median number of removed nodes was 14 in the lymphadenectomy group. The 5-year survival rate of 90% and 86% was achieved, respectively, for lymphadenectomy and no lymphadenectomy (p ¼ 0.501). Conclusions: Although systematic pelvic lymphadenectomy significantly improved surgical staging of women with clinical early-stage endometrial carcinoma by detecting a higher rate of patients with positive nodes, it did not improve overall survival.
Is lymphadenectomy a prognostic marker in endometrioid adenocarcinoma of the human endometrium?
BMC Cancer, 2010
Background: During surgery for endometrial cancer, a pelvic lymphadenectomy with or without para-aortic lymphadenectomy is performed at least in patients with risk factors (stage I, grading 2 and/or histological subtypes with higher risk of lymphatic spread), and is hence recommended by the International Federation of Obstetrics and Gynecology (FIGO). Although lymph node metastases are important prognostic parameters, it has been contentious whether a pelvic lymph node dissection itself has a prognostic impact in the treatment of endometrial cancer, especially in endometrioid adenocarcinoma. Therefore, this study evaluated whether lymphadenectomy has a prognostic impact in patients with endometrioid adenocarcinoma.
Lymph node evaluation in endometrial cancer: how did it change over the last two decades?
Translational Cancer Research, 2020
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and surgery represents the pivotal part of treatment. Hysterectomy and salpingo-oophorectomy allow removing the primary tumor and defining patients at higher risk, who might benefit from adjuvant therapies. Minimally invasive surgery is associated with superior postoperative outcomes and represents a safe and effective approach for surgical staging of EC. The lymph node status evaluation in EC is still a matter of debate. Over the last twenty years much has changed, moving from a full systematic pelvic and paraaortic lymphadenectomy for staging purpose to the removal of the pelvic (with or without paraaortic) lymph nodes only in selected EC classes of risk. Two randomized trials failed to demonstrate survival benefits of lymphadenectomy in case of apparent early stage EC; however, its prognostic role has never been questioned. At present, with the aim of reducing the surgical-related morbidit...
Lymphadenectomy in endometrial cancer - achieving more with less?
Minim Invasive Ther Allied Technol., 2021
The lymph node status of patients with endometrial cancer is known to be a crucial determinant for the prognosis of the disease. It also provides the indication for further adjuvant treatment. The staging of endometrial cancer by surgery has been a controversial issue for more than 30 years. The significant complication rate after lymphadenectomy and the development of minimally invasive surgery have led to the use of sentinel lymph node (SLN) mapping. In the present review, we present the development of surgical staging procedures in patients with endometrial cancer and summarize the recently expanding body of published literature on the subject. SLN mapping is a safe and accurate technique, especially when indocyanine green is used as a tracer. SLN mapping appears to reduce complication rates as well as costs without affecting the oncologic outcome. Large prospective studies are needed to establish the effects of SLN mapping on the outcome of disease, especially in high-risk patients with endometrial cancer. Furthermore, the need for additional systematic lymphadenectomy prior to adjuvant radio-chemotherapy in patients diagnosed with isolated lymph node metastasis during SLN biopsy must be investigated further. This might pave the way for a new surgical approach in patients with endometrial cancer.
The role of lymphadenectomy in patients with endometrial cancer
J Gynecol Women’s Health, 2016
Endometrial cancer (EC) represents the most common malignancy of the female genital tract in developed countries [1-10]. Current international guidelines (ACOG, FIGO, SGO, ESGO and ESMO), recommend systematic surgical staging as the initial treatment approach for all types of EC [type I (endometrioid) and type II (serous, clear cell, undifferentiated)] [2-4,6-15]. This is mainly because systematic surgical staging offers many diagnostic, prognostic and therapeutic benefits for these patients [2-4,6-13].