H B Salvesen1. 1. Kvinneklinikken Haukeland Sykehus 5021 Bergen. hesa@haukeland.no
Abstract
BACKGROUND: Complete surgical removal of cancer tissue is a goal in modern cancer treatment, and this is one of the arguments for total lymphadenectomy in gynaecologic cancer surgery. MATERIAL AND METHODS: Review of the literature identified through limited searches on Medline, Cochrane, Bibsys and the Internet. RESULTS: Lymphadenectomy improves the staging and represent advanced surgical treatment with considerable complication rates, related to the surgeon's experience. It is likely that lymphadenectomy directly influences survival for vulva and cervical cancer. The effect on survival among endometrial and ovarian cancer patients is unsettled, but prospective randomized trials are ongoing. INTERPRETATION: Correct staging is especially important in randomized trials of treatment alternatives, and it is the basis for individualised treatment. However, the effect of available treatment is not always well documented, hence the mortality and complication rates related to the procedure should be considered in relation to the potential benefit from the relevant treatment in each patient. Special training in the surgical technique is necessary. For rare conditions, this implies centralization. There are promising new approaches like the sentinel node and laparoscopic techniques, and studies of prognostic tumour markers, that may partially replace total lymphadenectomy in the future.
BACKGROUND: Complete surgical removal of cancer tissue is a goal in modern cancer treatment, and this is one of the arguments for total lymphadenectomy in gynaecologic cancer surgery. MATERIAL AND METHODS: Review of the literature identified through limited searches on Medline, Cochrane, Bibsys and the Internet. RESULTS: Lymphadenectomy improves the staging and represent advanced surgical treatment with considerable complication rates, related to the surgeon's experience. It is likely that lymphadenectomy directly influences survival for vulva and cervical cancer. The effect on survival among endometrial and ovarian cancerpatients is unsettled, but prospective randomized trials are ongoing. INTERPRETATION: Correct staging is especially important in randomized trials of treatment alternatives, and it is the basis for individualised treatment. However, the effect of available treatment is not always well documented, hence the mortality and complication rates related to the procedure should be considered in relation to the potential benefit from the relevant treatment in each patient. Special training in the surgical technique is necessary. For rare conditions, this implies centralization. There are promising new approaches like the sentinel node and laparoscopic techniques, and studies of prognostic tumour markers, that may partially replace total lymphadenectomy in the future.