Complications of lymphadenectomy for gynecologic cancer

Achouri, A.; Huchon, Cyrille; Bats, Anne-Sophie; Bensaïd, C.; Nos, Claude; Lécuru, Fabrice

doi:10.1016/j.ejso.2012.10.011

Cited by 192 publications

(162 citation statements)

References 28 publications

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“…In Press(In Press):e63858. (8,9). The patient in this study underwent cytoreductive surgery, extensive pelvic and para-aortic lymphadenectomy, heparin prophylaxis, and placing drain for drainage.…”

Section: Discussionmentioning

confidence: 99%

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Seresht

Izadi

Yousefi

et al. 2017

J Obstet Gynecol Cancer Res

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Introduction: In patients with female genital tract cancers, during treatment, differentiating between a tumor recurrence and a benign phenomenon is of great importance. This study aimed to report a case of retroperitoneal lymphocele in a patient with primary ovarian cancer. Case Presentation: A 49-year-old woman diagnosed with papillary serous ovarian carcinoma was referred to the oncology clinic in 2017. She was treated with an optimal surgical staging and underwent adjuvant chemotherapy. After 3 courses of chemotherapy, she complained of a large abdominal mass in the umbilical area. Evaluating the mass confirmed retroperitoneal lymphocele, which was treated with a non-surgical therapy. Conclusions: Pelvic mass in patients with previous ovarian cancer is not necessarily due to the recurrence of the tumor and the possibility of lymphocele diagnosis should be considered. Since preventing the causes of lymphocele is very difficult, it is only necessary to carefully follow-up and provide essential consultations for highrisk patients.

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Section: Discussionmentioning

confidence: 99%

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Seresht

Izadi

Yousefi

et al. 2017

J Obstet Gynecol Cancer Res

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“…Although the systematic procedure should, in principle, offer better protection against metastasis and recurrence, the current systematic review of studies involving a total of >50,000 patients from 6 countries suggests that systematic lymphadenectomy does not reliably improve survival time over no systematic lymphadenectomy when patients of all endometrial cancer risk classes are combined. In addition, the systematic procedure may be associated with higher rates of complications, including lymphedema and lymphocysts, which reduce postoperative quality of life and increase risk of mortality (12,25).…”

Section: Discussionmentioning

confidence: 99%

“…However, to try to treat and prevent metastases, physicians often perform systematic lymphadenectomy, which involves removing ≥11 lymph nodes in the same area covered by non-systematic lymphadenectomy (9,10). Systematic lymphadenectomy is significantly more invasive than the non-systematic procedure, and leaves patients with markedly lower postoperative lymph function, increasing the risk of various complications (12). Given the controversy regarding whether systematic lymphadenectomy is justified for patients with early-stage endometrial cancer, the present study aimed to examine its safety and efficacy by systematically reviewing the literature.…”

Section: Introductionmentioning

confidence: 99%

Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: A systematic review

Li¹,

Zhong

et al. 2016

Oncology Letters

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Abstract. The purpose of the current review was to examine whether systematic lymphadenectomy is safe and effective for treating early-stage endometrial cancer. PubMed, Embase, the Cochrane Library and the China National Knowledge Infrastructure databases were systematically searched during April 2014 to identify studies comparing the use of systematic lymphadenectomy and no systematic lymphadenectomy in parallel for the treatment of early-stage endometrial cancer. A total of 13 eligible studies involving 51,155 patients were included in this review. The median overall survival (OS) rate at 5 years following lymphadenectomy was 90% (range, 73.1-98.3%) for patients undergoing the systematic procedure and 88.2% (range, 68-98.4%) for patients not undergoing the systematic procedure. For the two types of lymphadenectomy, OS has tended to improve over the last 20 years. The combined rate of disease-free and progression-free survival was higher in patients who underwent systematic lymphadenectomy, and the recurrence rate was lower. In particular, systematic lymphadenectomy was associated with markedly higher OS than the non-systematic procedure for patients with intermediate-and high-risk endometrial cancer when ≥11 lymph nodes were removed. Systematic lymphadenectomy demonstrates clinical benefit in patients with early-stage endometrial cancer and should thus be a standard treatment option. In conclusion, systematic lymphadenectomy leads to higher OS than no systematic lymphadenectomy in intermediate-and high-risk patients with early-stage endometrial cancer, particularly when the procedure removes ≥11 lymph nodes.

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“…When the 2 procedures are found to be equal, abstaining from systematic lymphadenectomy would safeguard lymph node-negative patients from an associated 2% intraoperative risk of vascular, nerve, bowel, or ureteric injury (37). Also, long-term morbidity caused by lymphedema and infected lymphocysts can be minimized and will likely improve quality of life (30,38).…”

Section: Discussionmentioning

confidence: 99%

^99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis

et al. 2015

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We aimed to compare SPECT/CT and lymphoscintigraphy on overall and bilateral sentinel lymph node (SLN) detection in cervical cancer patients. Methods: A systematic search was performed on August 1, 2014, in PubMed, Embase, Scopus, and the Cochrane library. The syntax was based on synonyms of the terms cervical cancer, SPECT/CT, and lymphoscintigraphy. Retrieved articles were screened on their title/abstract and considered eligible when an SLN procedure was performed using both imaging modalities and if detection results were reported. Two independent reviewers assessed all included studies on methodologic quality using QUADAS-2. Studies were pooled on their odds ratios (ORs) with a randomeffects model. Results: The search yielded 962 unique articles, of which 8 were ultimately included. The studies were recent retrospective or prospective cohort studies of limited size (n 5 7-51) but sufficient methodologic quality. The median overall detection ($1 SLN in a patient) was 98.6% for SPECT/CT (range, 92.2%-100.0%) and 85.3% for lymphoscintigraphy (range, 70.0%-100.0%). This corresponded to a pooled overall SLN detection OR of 2.5 (95% CI, 1.2-5.3) in favor of SPECT/CT. The reported median bilateral detection ($1 SLN in each hemipelvis) was 69.0% for SPECT/CT (range, 62.7%-79.3%) and 66.7% for lymphoscintigraphy (range, 56.9%-75.8%), yielding a pooled OR of 1.2 (95% CI, 0.7-2.1). No significant difference in the number of visualized SLNs was observed at a pooled ratio of 1.2 (95% CI, 0.9-1.6). In recent years, the sentinel lymph node (SLN) procedure has been increasingly adopted in the staging of cervical cancer patients eligible for surgery. The SLN procedure allows for individualized treatment decisions by accurately ascertaining the lymph node status before radical surgery takes place (1), with the possibility of excluding fertility-sparing surgery or replacing a radical hysterectomy with chemoradiotherapy in patients with tumorpositive lymph nodes.Besides blue dye, the colloid-bound radionuclide 99m Tc is commonly added as a second tracer and has been shown to improve intraoperative SLN detection (2). A second advantage of this tracer is that preoperative lymphatic mapping by either SPECT/ CT or planar lymphoscintigraphy becomes possible, enabling prediction of the surgical detectability and number of SLNs in an individual patient. This ability aids the surgeon in performing a more direct SLN resection with less disruption of the lymphatic architecture when compared with a full retroperitoneal exploration (3-5).Although SPECT/CT is associated with both increased upfront cost and ionizing radiation, it provides a cross-sectional anatomic reference that allows for accurate 3-dimensional SLN localization, which is considered an important advantage over planar lymphoscintigraphy (5-9). Both SPECT/CT and lymphoscintigraphy should ideally have a high SLN detection ability, which largely determines the clinical value of the entire procedure.On the basis of a systematic search of the literature, we compared detection of ...

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Complications of lymphadenectomy for gynecologic cancer

Cited by 192 publications

References 28 publications

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Retroperitoneal Lymphocele in a Patient with Primary Ovarian Cancer: A Case Report

Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: A systematic review

^99mTc SPECT/CT Versus Planar Lymphoscintigraphy for Preoperative Sentinel Lymph Node Detection in Cervical Cancer: A Systematic Review and Metaanalysis

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