Sara Imboden1, Liliana Mereu2, Franziska Siegenthaler2, Alice Pellegrini3, Andrea Papadia2, Saverio Tateo3, Michael D Mueller2. 1. Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland. Electronic address: sara.imboden@insel.ch. 2. Department of Obstetrics and Gynecology, University Hospital of Bern and University of Bern, Bern, Switzerland. 3. Department of Obstetrics and Gynecology, Ospedale Santa Chiara di, Trento, Italy.
Abstract
BACKGROUND: and Purpose: In endometrial cancer, staging is performed surgically. Controversy about the required extent of lymph node removal is ongoing. In low-risk endometrial cancer (FIGO Stage 1, endometrioid histology, Grades 1 and 2), the risk of lymph-node involvement is 4-17%. Since the introduction of near-infrared optics and the use of indocyanine green, the role of sentinel lymph node removal is increasing and could offer an appropriate balance between the morbidity of a complete lymph-node dissection and the risk of missing lymph-node involvement. METHODS: In this retrospective comparative study on low-risk endometrial cancer, the extent of surgical lymph-node assessment (no lymphadenectomy vs removal vs lymphadenectomy) in two European institutions was compared and analyzed on the basis of perioperative data and oncological outcome. RESULTS: The study included 279 patients from: 103 (36.9%) had no lymphadenectomy, 118 (42.3%) underwent SLN removal and 58 (20.8%) underwent pelvic and/or para-aortic lymphadenectomy. There were significant differences among the groups in blood loss (p = 0.000), operation time (p = 0.000), and severity of postoperative complications (p = 0.063). In comparing only sentinel lymph-node removal vs no lymphadenectomy, there were no significant differences. No significant difference was seen between the extent of lymphadenectomy removal and the risk of recurrence. Age and Lymphovascular space invasion positivity were significant risk factors for recurrence (p = 0.004 and p = 0.019). CONCLUSIONS: In early-stage, endometrial cancer, Grade 1 and 2, sentinel lymph node removal offers a convincing balance between oncological safety and perioperative morbidity. Especially in LVSI-positive cases, lymph-node evaluation in any form is crucial.
BACKGROUND: and Purpose: In endometrial cancer, staging is performed surgically. Controversy about the required extent of lymph node removal is ongoing. In low-risk endometrial cancer (FIGO Stage 1, endometrioid histology, Grades 1 and 2), the risk of lymph-node involvement is 4-17%. Since the introduction of near-infrared optics and the use of indocyanine green, the role of sentinel lymph node removal is increasing and could offer an appropriate balance between the morbidity of a complete lymph-node dissection and the risk of missing lymph-node involvement. METHODS: In this retrospective comparative study on low-risk endometrial cancer, the extent of surgical lymph-node assessment (no lymphadenectomy vs removal vs lymphadenectomy) in two European institutions was compared and analyzed on the basis of perioperative data and oncological outcome. RESULTS: The study included 279 patients from: 103 (36.9%) had no lymphadenectomy, 118 (42.3%) underwent SLN removal and 58 (20.8%) underwent pelvic and/or para-aortic lymphadenectomy. There were significant differences among the groups in blood loss (p = 0.000), operation time (p = 0.000), and severity of postoperative complications (p = 0.063). In comparing only sentinel lymph-node removal vs no lymphadenectomy, there were no significant differences. No significant difference was seen between the extent of lymphadenectomy removal and the risk of recurrence. Age and Lymphovascular space invasion positivity were significant risk factors for recurrence (p = 0.004 and p = 0.019). CONCLUSIONS: In early-stage, endometrial cancer, Grade 1 and 2, sentinel lymph node removal offers a convincing balance between oncological safety and perioperative morbidity. Especially in LVSI-positive cases, lymph-node evaluation in any form is crucial.
Authors: Fernando Dip; Luigi Boni; Michael Bouvet; Thomas Carus; Michele Diana; Jorge Falco; Geoffrey C Gurtner; Takeaki Ishizawa; Norihiro Kokudo; Emanuele Lo Menzo; Philip S Low; Jaume Masia; Derek Muehrcke; Francis A Papay; Carlo Pulitano; Sylke Schneider-Koraith; Danny Sherwinter; Giuseppe Spinoglio; Laurents Stassen; Yasuteru Urano; Alexander Vahrmeijer; Eric Vibert; Jason Warram; Steven D Wexner; Kevin White; Raul J Rosenthal Journal: Ann Surg Date: 2022-04-01 Impact factor: 13.787
Authors: Tilman T Rau; Mona V Deppeler; Lucine Christe; Franziska Siegenthaler; Sara Imboden; Andrea Papadia; Michael D Mueller Journal: Virchows Arch Date: 2022-07-19 Impact factor: 4.535