Does debulking of enlarged positive lymph nodes improve survival in different gynaecological cancers?

Somashekhar, S. P.

doi:10.1016/j.bpobgyn.2015.04.010

Cited by 8 publications

(5 citation statements)

References 57 publications

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“…No prospective studies demonstrated that systematic lymphadenectomy could improve DFS and OS among EC patients . However, patients with regional lymph node disease (pelvic and/or retroperitoneal) are usually treated with cytoreductive surgery (CS) to ensure the complete resection of all macroscopic lesions but not necessarily systematic lymphadenectomy if these patients undergo postoperative radiotherapy. However, a retrospective study of 12,333 patients showed that lymphadenectomy with the removal of more than 20 lymph nodes significantly improved the survival of patients with lymph node‐positive disease, favoring the use of systematic lymphadenectomy rather than resection of clinically compromised lymph nodes.…”

Section: Resultsmentioning

confidence: 99%

“…33 Among the SLNM methods, indocyanine green (ICG) fluorescence has the highest accuracy. [33][34][35] A meta-analysis of 55 studies and 4915 patients found that the rate of SLN detection with SLNM was 81% (95% confidence interval, 77-84) vs 50% for bilateral detection (95% confidence interval, [44][45][46][47][48][49][50][51][52][53][54][55][56]. In addition, the rate of bilateral detection with ICG fluorescence was higher than that with patent blue (74.6% vs 50.5%), and the false-negativity rate of the former was less than 5% per hemipelvis.…”

Section: Is Intraoperative Gross Examination (Ige) Performed By a Surmentioning

confidence: 99%

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Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

Ribeiro

Cintra

Barrozo

et al. 2019

Journal of Surgical Oncology

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Background Approximately 70% of cancer‐related deaths occur in low‐ and middle‐income countries. In addition to social and racial inequalities, treatment options in these countries are usually limited because of the lack of trained staff and equipment, limited patient access to health services, and a small number of clinical guidelines. Objectives The Brazilian Society of Surgical Oncology developed this guideline to address these barriers and guide physicians treating patients with endometrial cancer (EC) in regions with limited resources and few specialized centers. Methods The guideline was prepared from 10 January to 25 October 20192019 by a multidisciplinary team of 56 experts to discuss the main obstacles faced by EC patients in Brazil. Thirteen questions considered critical to the surgical treatment of these patients were defined. The questions were assigned to groups that reviewed the literature and drafted preliminary recommendations. Following a review by the coordinators and a second review by all participants, the groups made final adjustments for presentations in meetings, classified the level of evidence, and voted on the recommendations. Results For all questions including staging, fertility spearing treatment, genetic testing, sentinel lymph node use, surgical treatment, and other clinical relevant questions, major agreement was achieved by the participants, always using accessible alternatives. Conclusions It is possible to provide adequate treatment for most EC patients in resource‐limited areas, but the first option should be referral to specialized centers with more resources.

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Section: Resultsmentioning

confidence: 99%

Section: Is Intraoperative Gross Examination (Ige) Performed By a Surmentioning

confidence: 99%

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

Ribeiro

Cintra

Barrozo

et al. 2019

Journal of Surgical Oncology

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“…However, due to the low rate of lymph node metastasis in cervical cancer, the survival benefit of lymphadenectomy remains controversial. The survival benefit of lymph node dissection can be analyzed by two ways, direct survival benefit following resection of bulky positive metastatic lymph and indirect survival benefit due to proper disease staging and stage migration and tailored adjuvant therapy ( 19 ). A previous SEER study showed that more extensive lymphadenectomy (>30 nodes removed) improved survival in node-negative patients but had no effect on survival in node-positive patients ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

Impact of examined lymph node number on lymph node status and prognosis in FIGO stage IB-IIA cervical squamous cell carcinoma: A population-based study

et al. 2022

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ObjectiveWe aimed to investigate the association of examined lymph node (ELN) number with lymph node status and long-term survival in FIGO stage IB-IIA cervical squamous cell carcinoma(CSCC) and to determine the minimum number of ELN associated with survival improvement.MethodData from the Surveillance, Epidemiology, and End Results Program (SEER) database of FIGO stage IB-IIA CSCC patients undergoing hysterectomy and pelvic lymphadenectomy in 2004-2016 were analyzed to explore the relationship between ELN number and lymph node status and overall survival (OS) by using the multivariable approach. The estimated probability of falsely identifying a patient as node-negative and the hazard ratios (HRs) for each ELN was fitted with a LOWESS smoother, and the structural breakpoints were determined. X-tile software was used to determine the optimal cutoff value for ELNs.ResultsA total of 2627 patients were analyzed. The optimal cutoff value of the ELN number was identified as 7 based on the results of X-tile software. The structural breakpoints according to the associations between the number of ELNs and the estimated risk of false-negative lymph node dissection and HRs for overall survival were 9 and 8, respectively. The multivariate analysis indicated that ELN number was an independent prognostic factor for OS, both as a continuous or categorical variable. To further explore the effect of more ELNs on survival, another cutoff value of 17 was chosen to compare the survival curves of patients. The multivariate-adjusted COX model showed that patients with ELN<8 had a significantly higher risk of death than those with ELN8-17 (HR=1.447, 95% CI =1.075-1.947, p=0.015), but there was no significant difference in overall survival between patients with ELN>17 and patients with ELN8-17 (HR=0.822, 95%CI =0.665-1.016, p=0.070).ConclusionA sufficient number of ELNs was associated with better long-term survival in FIGO stage IB-IIA CSCC. At least 8 ELNs need to be examined for prognostic stratification. Excessive lymph node dissection (ELN>17) may not confer additional survival benefits.

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“…Due to the nature of lymphatic spread of ovarian cancer, 50% to 75% of patients with advanced stage cancer will have retroperitoneal lymph node involvement. 29 Nevertheless, there are still concerns among surgeons about the patient morbidity and benefit of systematic lymphadenectomy. 22 A randomized, multicenter trial for lymphadenectomy in ovarian neoplasms is currently underway.…”

Section: Discussionmentioning

confidence: 99%

Current South African clinical Practice in Debulking Surgery for Ovarian Cancer

Billson

Merwe²,

Soeters³

2016

Int J Gynecol Cancer

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Does debulking of enlarged positive lymph nodes improve survival in different gynaecological cancers?

Cited by 8 publications

References 57 publications

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

Brazilian Society of Surgical Oncology guidelines for surgical treatment of endometrial cancer in regions with limited resources

Impact of examined lymph node number on lymph node status and prognosis in FIGO stage IB-IIA cervical squamous cell carcinoma: A population-based study

Current South African clinical Practice in Debulking Surgery for Ovarian Cancer

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