Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm

Multinu, Francesco; Ducie, J.A.; Eriksson, Ane Gerda Zahl; Schlappe, Brooke A.; Cliby, William A.; Glaser, Gretchen; Grassi, Tommaso; Keeney, Gary L.; Weaver, Amy L.; Abu‐Rustum, Nadeem R.; Leitao, Mario M.; Mariani, Andrea

doi:10.1016/j.ygyno.2019.09.011

Cited by 41 publications

(50 citation statements)

References 39 publications

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“…In stage IIIC EC, a recent study by Multinu et al concluded that LND can be omitted from surgical staging of "non-bulky" nodal disease as combined adjuvant therapy (chemotherapy and EBRT) proved to be effective alone (39) . This result cannot be extrapolated to "bulky" and "suspicious nodes", as these were not included in this study.…”

Section: The Role Of Lymph Node Dissection In Advanced Endometrial Camentioning

confidence: 99%

“…The effect of LND on non-endometrioid type cancers is not well-characterised given the low number of this histological subtype (39) . Therapy options are limited for advanced EC with extra-abdominal metastases, and there is no widely acknowledged agreement regarding treatment of stage IVB EC (5,44) .…”

Section: The Role Of Lymph Node Dissection In Advanced Endometrial Camentioning

confidence: 99%

“…Special attention is needed for isolated positive para-aortic LNs (35) . Surgical Method: Minimally invasive surgery (MIS) is preferred over laparotomy based on ESMO-ESGO-ESTRO 2016 (5,(36)(37)(38) while laparotomy is preferred for complex cases (39) . Within MIS, robotic and laparoscopic LND shows similar adequacy (38)(39)(40) while robotic has certain advantages over laparoscopic surgery (38,41,42) .…”

Section: Perspective Title Perspectives Summarymentioning

confidence: 99%

“…Surgical Method: Minimally invasive surgery (MIS) is preferred over laparotomy based on ESMO-ESGO-ESTRO 2016 (5,(36)(37)(38) while laparotomy is preferred for complex cases (39) . Within MIS, robotic and laparoscopic LND shows similar adequacy (38)(39)(40) while robotic has certain advantages over laparoscopic surgery (38,41,42) . Role of sentinel lymph node (SLN) dissection: ESMO-ESGO-ESTRO recognises SLN algorithms as a potential alternative to systematic LND in early stage EC (5,43) supported by recent studies (23,36,44) .…”

Section: Perspective Title Perspectives Summarymentioning

confidence: 99%

See 3 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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Section: The Role Of Lymph Node Dissection In Advanced Endometrial Camentioning

confidence: 99%

Section: The Role Of Lymph Node Dissection In Advanced Endometrial Camentioning

confidence: 99%

Section: Perspective Title Perspectives Summarymentioning

confidence: 99%

Section: Perspective Title Perspectives Summarymentioning

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

View full text Add to dashboard Cite

show abstract

“…[38][39][40] Although the indication of adjuvant treatment for these cases remains debatable, there is a tendency for adjuvant treatment of patients with micrometastases. A retrospective study 41…”

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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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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Can risk groups accurately predict non‐sentinel lymph node metastasis in sentinel lymph node‐positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO‐SLN‐004)

Altın

Taşkın

Tokgözoğlu

et al. 2020

Journal of Surgical Oncology

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Background and ObjectivesThe purpose of this study was to find out the risk factors associated with non‐sentinel lymph node metastasis and determine the incidence of non‐sentinel lymph node metastasis according to risk groups in sentinel lymph node (SLN)‐positive endometrial cancer patients.MethodsPatients who underwent at least bilateral pelvic lymphadenectomy after SLN mapping were retrospectively analyzed. Patients were categorized into low, intermediate, high‐intermediate, and high‐risk groups defined by ESMO‐ESGO‐ESTRO.ResultsOut of 395 eligible patients, 42 patients had SLN metastasis and 16 (38.1%) of them also had non‐SLN metastasis. Size of SLN metastasis was the only factor associated with non‐SLN metastasis (p = .012) as 13/22 patients with macrometastasis, 2/10 with micrometastasis and 1/10 with isolated tumor cells (ITCs) had non‐SLN metastasis. Although all 4 metastases (1.8%) among the low‐risk group were limited to SLNs, the non‐SLN involvement rate in the high‐risk group was 42.9% and all of these were seen in patients with macrometastatic SLNs.ConclusionsNon‐SLN metastasis was more frequent in higher‐risk groups and the risk of non‐SLN metastasis increased with the size of SLN metastasis. Proceeding to complete lymphadenectomy when SLN is metastatic should further be studied as the effect of leaving metastatic non‐SLNs in‐situ is not known.

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Role of lymphadenectomy in endometrial cancer with nonbulky lymph node metastasis: Comparison of comprehensive surgical staging and sentinel lymph node algorithm

Cited by 41 publications

References 39 publications

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

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

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

Can risk groups accurately predict non‐sentinel lymph node metastasis in sentinel lymph node‐positive endometrial cancer patients? A Turkish Gynecologic Oncology Group Study (TRSGO‐SLN‐004)

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