scholarly journals Lymphadenectomy for oncogynecological pathology: evaluation of lymph cyst formation and detection of metastases depending on the number of lymph nodes removed

2021 ◽  
Vol 20 (4) ◽  
pp. 31-37
Author(s):  
V. V. Saevets ◽  
Yu. A. Semenov ◽  
A. A. Muhin ◽  
A. V. Taratonov ◽  
M. N. Ivahno ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Radical Hysterectomy ◽  
Disease Recurrence ◽  
Surgical Staging ◽  
Cancer Group ◽  
Metastatic Lesions ◽  
Paraaortic Lymphadenectomy ◽  
Risk Of Disease ◽  
Lymphatic Cysts

Introduction. Lymphadenectomy in gynecological oncology allows performing adequate surgical staging, determining the need for adjuvant therapy, and reducing the risk of disease recurrence. An increase in the volume of lymphadenectomy leads to an increase in the incidence of postoperative complications — the formation of lymphatic cysts. There are no clear recommendations on the required number of removed lymph nodes in order to identify their metastatic lesions. The aim of the study was to study the possible dependence of the number of removed lymph nodes and the formation of lymphatic cysts. Materials and methods. A retrospective study of 219 patients after surgical treatment from 2020 to 2021 was carried out on the basis of GBUZ Chelyabinsk Regional Center of Oncology and Nuclear Medicine. The study included cases of stage I-IV uterine cancer of all histological types, which underwent radical hysterectomy with bilateral pelvic or bilateral pelvic and paraaortic lymphadenectomy; cases of cervical cancer stage IA1-IIA disease after radical hysterectomy II-III type according to the classification of M.S. Piver, F. Rutledge (1974) with performing bilateral pelvic lymphadectomy. Statistical processing of the results was carried out. Results. The percentage of complications (lymphatic cysts) in the cervical cancer group was 2.06% (N = 2), in the uterine body cancer group 1.72 (N = 2). There was no statistically significant relationship between the removed lymph nodes and their metastatic lesions. Removing more than 27 lymph nodes is a risk factor for developing lymphatic cysts. Discussion. Lymphadenectomy allows for adequate surgical staging and reduces the risk of disease recurrence. Complicated lymphatic cysts occur in 0.9-34% of cases, which was reflected in our study, but the percentage of these complications is quite low. Conclusion. The increase in the volume of lymphadenectomy (removal of more lymph nodes) is justified by the desire for accuracy in the surgical staging of the tumor process. Despite this, there is a risk of complications after lymphadenectomy — the formation of lymphatic cysts that occurs when 27 or more lymph nodes are removed.

scholarly journals The value of sentinel lymphadenectomy in radical operative treatment of cervical cancer

2009 ◽  
Vol 66 (7) ◽  
pp. 539-543 ◽  
Author(s):  
Vladimir Pazin ◽  
Svetlana Dragojevic ◽  
Zeljko Mikovic ◽  
Milan Djukic ◽  
Snezana Rakic ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Sentinel Node ◽  
Cervical Carcinoma ◽  
Radical Hysterectomy ◽  
Predictive Value ◽  
Sentinel Nodes ◽  
Sentinel Lymphadenectomy ◽  
Stage Ib ◽  
The Mean

Background/Aim. Therapy of the early stages of cervical carcinoma is surgical or radiation therapy, and for advanced stages chemoradiotherapy. Pelvic and paraaortic lymphadenectomy in early stages offers the most important prognostic factor for survival. To evaluate the method and possible influence on surgical staging and therapy of the disease, we performed sentinel node (SN) identification and excision during open radical hysterectomy and lymphadenectomy in stage Ib-IIa cervical carcinoma. Methods. Fifty patients initially diagnosed with invasive squamous-cell cervical cancer stage Ib-IIa were included in the study. Only blue dye was used for sentinel node mapping. During the surgery sentinel nodes were identified and sent to histopathology separately from the other lymph nodes. After lymphadenectomy, radical hysterectomy was performed. Results. The mean age of our fifty patients was 49.10 years (SD = 5.92), and the mean number of extracted lymph nodes per patient was 25.78 (SD = 5.58). The number of sentinel nodes identified per patient was between 0 and 5, mean 2.60 (SD = 1.54). There were no inframesenteric paraaortic sentinel nodes found among the patients. The dominant tumor grades were 1 and 2, 40% and 50% respectively, and 37 out of 50 patients (74%) had tumor diameter less than 2 cm. In four patients (8%) SN were not identified. In the rest of 46 patients the presence of SN was bilateral (19 patients, 38%) or unilateral (27 patients, 54%). Positive SN were found in 17 patients (34%), and negative in 29 patients (58%). Out of the whole group of patients (50), 21 of them (42%) had positive lymph nodes (LN). In the crosstab statistics, no differences were noticed in the group without SN found, in comparison with tumor grade and diameter. Finally, our test showed sensitivity of 85% (SE = 8%), specificity 100%, positive predictive value of 100%, negative predictive value of 89.6% (SE = 5.6%), and effectiveness of 93% (SE = 3.6%) regarding sentinel lymphadenectomy. Conclusion. This method of sentinel lymph node identification is simple, but not reliable enough to support further laparoscopic SN excision in order to make the final decision about the treatment of cervical cancer.

scholarly journals Possibilities and limits of modern metods of diagnosis of distant metastases locallyadvanced cervical cancer

2013 ◽  
Vol 62 (2) ◽  
pp. 172-178
Author(s):  
Margarita Vitaliyevna Kargopolova ◽  
Sergey Yanovich Maksimov ◽  
Igor Viktorovich Berlev ◽  
Anzhella Slavikovna Khadzhimba ◽  
Oleg Fedorovich Chepik ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Combined Treatment ◽  
Laparoscopic Approach ◽  
Distant Metastases ◽  
Recurrent Cervical Cancer ◽  
Paraaortic Lymphadenectomy ◽  
Short Period ◽  
Paraaortic Lymph Nodes ◽  
A Prospective Study

A retrospective study of 245 cases of recurrent cervical cancer, in every third case was detected metastases in paraaortic lymph nodes. Given these results, a prospective study aimed at optimizing the staging of cervical cancer Ib1–IIIb stages. Analyzed 48 clinical cases of patients with locally - common forms of cervical cancer, which before the combined treatment paraaortic lymphadenectomy was performed through laparoscopy with subsequent histological examination of surgical specimens. At the preoperative stage, to identify distant metastasis in para-aortic lymph nodes, patients were examined by various methods of radiation diagnosis. The sensitivity of MRI was 75 %, specificity 79 %, sensitivity and specificity of ultrasonography – 75 % and 93 %, respectively. The positive predictive value of the test was 25 % MRI, ultrasound – 50 %. Performing paraaortic lymphadenectomy with the greatest possible to individualize treatment policy and, as a consequence, to improve the results of combined treatment of patients with locally-common forms of cervical cancer. The use of laparoscopic approach, given the short period of rehabilitation, has not led to the postponement of chemoradiotherapy.

Stage IB and IIA Cervical Cancer with Negative Lymph Nodes: The Role of Adjuvant Radiotherapy after Radical Hysterectomy

1997 ◽  
Vol 66 (1) ◽  
pp. 31-35 ◽  
Author(s):  
John O. Schorge ◽  
Kelly L. Molpus ◽  
Daniel Koelliker ◽  
Najmosama Nikrui ◽  
Annekathryn Goodman ◽  
...  
Keyword(s):  
Cervical Cancer ◽  
Lymph Nodes ◽  
Radical Hysterectomy ◽  
Adjuvant Radiotherapy ◽  
Stage Ib ◽  
Negative Lymph Nodes

How should we stage and tailor treatment strategy in locally advanced cervical cancer? Imaging versus para-aortic surgical staging

2020 ◽  
Vol 30 (9) ◽  
pp. 1434-1443
Author(s):  
Alejandra Martinez ◽  
Martina Aida Angeles ◽  
Denis Querleu ◽  
Gwenael Ferron ◽  
Christophe Pomel
Keyword(s):  
Cervical Cancer ◽  
Lymph Node ◽  
Lymph Node Metastasis ◽  
Lymph Nodes ◽  
Locally Advanced ◽  
Surgical Staging ◽  
Advanced Cervical Cancer ◽  
Locally Advanced Cervical Cancer ◽  
Node Metastasis ◽  
Pet Ct

Para-aortic lymph node status at initial assessment is the most important prognostic factor and a key point for the therapeutic strategy in patients with locally advanced cervical cancer. Undiagnosed lymph node metastasis is a major clinical problem as the finding of positive para-aortic lymph nodes leads to treatment modification, with a possible impact on disease free survival. When aortic lymph node disease is discovered, radiotherapy is extended to the para-aortic area, and other treatment modalities may be considered. Fluorine-18 fluorodeoxyglucose positron emission tomography/computed tomography (PET/CT) is the most accurate imaging examination to assess para-aortic extension in patients with locally advanced cervical cancer. The gold standard to identify para-aortic extension remains histologic evaluation of the lymph nodes. Indeed, PET/CT fails to detect approximately 10–15% of patients with negative PET/CT aortic nodes who have lymph node metastasis on pathologic staging. Patients with positive pelvic lymph nodes have para-aortic extension in 25–30% of cases, and surgical staging will lead to treatment modification and probably to improved para-aortic and distant control. Surgical staging also avoids unnecessary toxicity associated with extended field radiation in approximately 75% of patients with pelvic lymph node metastasis. The best modality to identify para-aortic extension is histological evaluation of the lymph nodes, but the survival benefit of surgical staging remains controversial. On the other hand, current studies include a majority of patients without pelvic lymph node spread, who are likely to be those who will benefit the least from surgical staging.

Resection of bulky positive lymph nodes in patients with cervical carcinoma

1995 ◽  
Vol 5 (4) ◽  
pp. 250-256 ◽  
Author(s):  
N. F. Hacker ◽  
G. V. Wain ◽  
J. L. Nicklin
Keyword(s):  
Cervical Cancer ◽  
Radiation Therapy ◽  
Lymph Nodes ◽  
Radical Hysterectomy ◽  
Median Number ◽  
Positive Lymph Node ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Computed Tomographic ◽  
Positive Lymph Nodes

From January 1987 to April 1992, 34 patients had resection of bulky positive lymph nodes, detected either at the time of radical hysterectomy (n= 23) or by computed tomographic (CT) scan of the pelvis and abdomen prior to radiation therapy for more advanced cervical cancer (n= 11). Following nodal resection, 33 patients received pelvic external beam radiation, 28 received pelvic and para-aortic radiation, and 23 received four cycles of cisplatin chemotherapy. The median number of resected positive nodes was 4, with a range of 1–44. All macroscopic nodal metastases could be resected in each patient and morbidity was acceptably low. Positive nodes were confined to the pelvis in 17 patients, involved the common iliac group in nine patients, and involved the para-aortic area in eight patients. With a mean follow-up of 36 months, 23 patients (67.6%) were alive, of whom 20 were free of disease. For patients having a radical hysterectomy, actuarial 5-year survival was 80% for patients with disease involving pelvic and common iliac lymph nodes, and 48% for those with positive para-aortic nodes. Survival for patients with completely resected bulky pelvic and common iliac nodes was comparable to that for patients with micrometastases. This study suggests that every effort should be made to identify patients with cervical cancer who have bulky positive lymph node metastases, and to remove these nodes surgically prior to radiation therapy.

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