Jvan Casarin, Gabriella Schivardi, Valeria Artuso, Anna Giudici, Tommaso Meschini, Luigi De Vitis, Vincenzo Granato, Antonio Lembo, Antonella Cromi, Andrea Mariani, Giorgio Bogani, Francesco Multinu, Fabio Ghezzi
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Data on patient characteristics, surgical details, and post-operative complications were collected. Lymphedema screening was performed using a validated questionnaire.</p><p><strong>Results: </strong>A total of 239 patients were analyzed, with a questionnaire response rate of 85.4%. The study population was grouped based on actual surgical staging: hysterectomy+SLN (54.8%), hysterectomy+systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). The prevalence of lymphedema was significantly lower in the hysterectomy+SLN group compared with the hysterectomy+systematic pelvic lymphadenectomy group (21.4% vs 44.6%, p=0.003). Multivariable analysis showed a threefold increase in the risk of lymphedema for the hysterectomy+systematic pelvic lymphadenectomy group compared with the hysterectomy+SLN group: OR 3.11 (95% CI 1.47 to 6.58). 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引用次数: 0
摘要
目的根据实际结节评估的类型，评估使用前哨淋巴结（SLN）算法对早期子宫内膜癌进行腹腔镜治疗时的淋巴特异性发病率（特别是下肢淋巴水肿）：一项前瞻性研究针对 2020 年 1 月至 2023 年 8 月期间在一家机构接受腹腔镜分期治疗的明显早期子宫内膜癌手术患者。研究人员收集了患者特征、手术细节和术后并发症等数据。使用有效问卷进行了淋巴水肿筛查：共分析了 239 名患者，问卷回复率为 85.4%。研究人群根据实际手术分期进行分组：子宫切除+SLN（54.8%）、子宫切除+系统性盆腔淋巴结切除（27.2%）和仅子宫切除（18%）。与子宫切除术+系统性盆腔淋巴结切除术组相比，子宫切除术+SLN组的淋巴水肿发生率明显较低（21.4% vs 44.6%，P=0.003）。多变量分析显示，与子宫切除术+SLN组相比，子宫切除术+系统性盆腔淋巴结切除术组发生淋巴水肿的风险增加了三倍：OR 3.11 (95% CI 1.47 to 6.58)。淋巴水肿与患者或肿瘤的其他特征无明显关联：在采用腹腔镜方法进行早期子宫内膜癌手术的情况下，与系统性淋巴结清扫相比，SLN图谱可显著减少淋巴并发症。我们的研究结果为在子宫内膜癌微创手术中采用 SLN 图谱提供了更多证据。该技术可确保相当的诊断准确性，并将并发症降至最低。
Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema.
Objective: To evaluate the lymphatic-specific morbidity (specifically, lower extremity lymphedema) associated with laparoscopic management of early-stage endometrial cancer using the sentinel lymph node (SLN) algorithm by type of actual nodal assessment.
Methods: An ambispective study was conducted on consecutive patients surgically treated for apparent early-stage endometrial cancer who underwent laparoscopic staging according to the National Comprehensive Cancer Network SLN algorithm at a single institution from January 2020 to August 2023. Data on patient characteristics, surgical details, and post-operative complications were collected. Lymphedema screening was performed using a validated questionnaire.
Results: A total of 239 patients were analyzed, with a questionnaire response rate of 85.4%. The study population was grouped based on actual surgical staging: hysterectomy+SLN (54.8%), hysterectomy+systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). The prevalence of lymphedema was significantly lower in the hysterectomy+SLN group compared with the hysterectomy+systematic pelvic lymphadenectomy group (21.4% vs 44.6%, p=0.003). Multivariable analysis showed a threefold increase in the risk of lymphedema for the hysterectomy+systematic pelvic lymphadenectomy group compared with the hysterectomy+SLN group: OR 3.11 (95% CI 1.47 to 6.58). No significant associations were found between lymphedema and other patient or tumor characteristics.
Conclusion: In the setting of a laparoscopic approach for early-stage endometrial cancer surgery, SLN mapping is associated with a significant reduction in lymphatic complications compared with a systematic lymph node dissection. Our findings provide additional evidence endorsing the adoption of SLN mapping during minimally invasive surgery for endometrial cancer. This technique ensures comparable diagnostic accuracy and also minimizes complications.
期刊介绍：
The International Journal of Gynecological Cancer, the official journal of the International Gynecologic Cancer Society and the European Society of Gynaecological Oncology, is the primary educational and informational publication for topics relevant to detection, prevention, diagnosis, and treatment of gynecologic malignancies. IJGC emphasizes a multidisciplinary approach, and includes original research, reviews, and video articles. The audience consists of gynecologists, medical oncologists, radiation oncologists, radiologists, pathologists, and research scientists with a special interest in gynecological oncology.
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