Extent of lymphadenectomy and postoperative major complications among women with endometrial cancer treated with minimally invasive surgery

Polan, R.M.; Rossi, Emma; Barber, Emma L.

doi:10.1016/j.ajog.2018.11.1102

Cited by 36 publications

(30 citation statements)

References 29 publications

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“…Studies have shown that cervical injection of indocyanine green (ICG) results in a consistently reliable pelvic SLN detection rate, even showing a superior detection rate than systematic lymphadenectomy, in both low- and high-risk endometrial cancer settings 3–5. With comparable disease-free and overall survival outcomes,6 SLN biopsy may increasingly replace systematic lymphadenectomy, which often causes surgical co-morbidities and lymphatic-specific complications, including lymphedema, lymphorrhea, and lymphoceles 7–9…”

Section: Introductionmentioning

confidence: 99%

Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

Kim

Eoh

Lee

et al. 2020

Int J Gynecol Cancer

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IntroductionFluorescence image-guided sentinel lymph node (SLN) biopsy using a two-step mapping technique incorporates sequential injection of indocyanine green into the bilateral uterine cornus, followed by cervical injection. Outcomes were compared with the conventional cervical (one-step) method .MethodsPatients with FIGO stage I-III endometrial cancer who underwent laparoscopic or robotic staging, including SLN biopsy, from May 2014 to December 2018, were retrospectively reviewed. Patient characteristics, pre-operative imaging, SLN detection pattern, pathologic result, adjuvant, and recurrence locations were analyzed.ResultsA total of 199 patients received one-step (n=123) and two-step (n=76) SLN biopsy. Para-aortic SLN were more frequently identified in the two-step group. Lower and upper para-aortic SLN were identified in 67.1% and 38.2%, respectively, in the two-step group and in 18.7% and 5.7% in the one-step group (p<0.001). The number of para-aortic SLN harvested was superior in the two-step group (p<0.001). Metastatic para-aortic SLN were found in 7.9% of the two-step group and 2.4% of the one-step group (p=0.070). In detecting nodal metastasis, the sensitivities of the one- and two-step methods were 91.7% and 100.0%, negative predictive values were 99.0% and 100.0%, false-negative rates were 8.3% and 0%, and accuracy rates were 99.1% and 100.0%, respectively. The one-step method identified only three out of eight para-aortic lymph node metastases and missed five para-aortic lymph node metastases. There was no missed para-aortic lymph node metastasis in the two-step group. Recurrence was observed in two patients (2.6%; vaginal vault and adrenal gland) in the two-step group and seven patients (5.7%) including three nodal recurrences in the one-step group (p=0.307).DiscussionTwo-step SLN mapping improved the para-aortic SLN detection rate, a known pitfall of conventional cervical injection. Proper evaluation of aortic nodal status will assist in the tailoring of adjuvant and prevent undertreatment of patients with isolated para-aortic metastasis.

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Section: Introductionmentioning

confidence: 99%

Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

Kim

Eoh

Lee

et al. 2020

Int J Gynecol Cancer

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Section: Surgical Methodsmentioning

confidence: 99%

“…EC surgical staging including pelvic and paraaortic LND can be conducted by minimally invasive surgery (MIS) or open laparotomy (49) . MIS has been associated with less complications with a reported overall rate of 7% (49) . However, extent of LND was unreported in all arms of this study, a potentially significant confounder (49) .…”

Section: Surgical Methodsmentioning

confidence: 99%

“…MIS has been associated with less complications with a reported overall rate of 7% (49) . However, extent of LND was unreported in all arms of this study, a potentially significant confounder (49) . The other benefits of MIS are well documented such as shorter hospital stay and faster recuperation than laparotomy (46,50) , as recommended by ESMO-ESGO-ESTRO 2016 (Table 3) and further supported by a recent RCT (46) .…”

Section: Surgical Methodsmentioning

confidence: 99%

“…In summary due to the variations in morbidity (49) , further review of minimally invasive LND surgical methods is needed.…”

Section: Surgical Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The role of lymph node dissection in endometrial cancer: a systematic scoping review.

Kufour¹,

Thornton-Wood²,

Allen³

et al. 2020

Preprint

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Background: Surgical staging including lymph node dissection (LND) is considered the gold standard method of evaluating LN status and guiding adjuvant therapy in endometrial cancer (EC). The standard surgical treatment of EC includes systematic LND, which is associated with morbidity. Consequently, there is debate weighing the risks and benefits of LND. Objectives: To evaluate the role of LND in all stages of EC. Search Strategy: Systematic search of MEDLINE up to 9th January 2020 including references of relevant studies. Selection Criteria: Published literature in English describing LND in EC. Data Collection and Analysis: 176 articles were screened by title and abstract to select those describing roles of LND in EC. Main Results: We confirmed the diagnostic role of LND and the benefits of risk stratifying early-stage EC patients, despite variations in stratification systems. Low and high-risk groups have well-established guidelines. The role of LND remains controversial in intermediate and high-intermediate risk groups. Sentinel lymph node dissection seems promising to prevent under-/overtreatment. In all risk groups, the prognostic role of LND is well-understood however therapeutic use is debatable. In most stages of advanced EC, LND is beneficial, except for non-bulky nodal disease. Variation exists in what constitutes adequate LN counts, targets and surgical methods. Conclusions: International standardisation of the definition of LND and further adoption of sentinel lymph node algorithms is required. Future research should investigate the need to stratify for bulky and non-bulky nodal disease in advanced EC. New RCTs are needed to guide revaluation of the ESMO-ESGO-ESTRO 2016 guidelines. Funding There were no costs associated with conducting or writing this review.

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Postoperative complications in women with ovarian cancer stratified by cytoreductive surgery outcome

Polan

Slota

Barber

2023

Journal of Surgical Oncology

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ObjectiveTo compare 30‐day postoperative complications for patients with advanced ovarian cancer who underwent resection to no gross residual disease versus optimal and suboptimal cytoreduction.MethodsA retrospective cohort study of women drawn from the National Surgical Quality Improvement Program who underwent cytoreductive surgery for advanced ovarian cancer between 2014 and 2019 was performed. Exposure of interest was extent of surgical resection defined as no gross residual disease; residual disease <1 cm (optimal); and residual disease >1 cm (suboptimal). Primary outcome was postoperative complication. Associations were examined with bivariable tests and multivariable logistic regression.ResultsA total of 2248 women underwent cytoreductive surgery; 68.4% (n = 1538) underwent resection to no gross residual disease, 22.4% (n = 504) had an optimal, and 9.2% (n = 206) had a suboptimal cytoreduction. Optimal cytoreduction patients had the highest rates of any postoperative complication (35.5%, p < 0.001). They also had the longest operative times and procedures that were most surgically complex (203 min, 43.6 relative value units, both p < 0.05). However, patients who underwent optimal cytoreduction did not have increased odds of major complications (adjusted odds ratio: 1.20, 95% confidence interval: 0.91–1.58).ConclusionPatients who underwent optimal cytoreduction had more postoperative complications, required the most operating room time, and represented more complex surgeries compared with suboptimal cytoreduction or resection to no gross residual disease.

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Extent of lymphadenectomy and postoperative major complications among women with endometrial cancer treated with minimally invasive surgery

Cited by 36 publications

References 29 publications

Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

Comparison of outcomes between the one-step and two-step sentinel lymph node mapping techniques in endometrial cancer

The role of lymph node dissection in endometrial cancer: a systematic scoping review.

Postoperative complications in women with ovarian cancer stratified by cytoreductive surgery outcome

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