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Pelvic and periaortic lymphadenectomy in the treatment of endometrial cancer

Marcin Opławski1, Zbigniew Kojs2,Radosław Kosobucki2, Magdalena Smoczyńska3

Affiliacja i adres do korespondencji
CURR. GYNECOL. ONCOL. 2013, 11 (2), p. 151–158
DOI: 10.15557/CGO.2013.0014
Streszczenie

Treatment of endometrial cancer includes surgery, radiotherapy, chemotherapy, and hormonal therapy. Since early 1990s, a matter of much controversy remains the scope of surgery, particularly in the context of excision of lymph nodes. Currently valid surgical classification of clinical stages entails the need to assess the presence of metastases to pelvic and periaortic nodes (FIGO 2009). Technique of mapping sentinel nodes in endometrial cancer is currently being developed and is inherently complicated due to several routes of lymphatic drainage from the uterus. Excision of lymph nodes should be a part of routine surgical staging, as apart from diagnostic-prognostic value, it is of paramount significance for clinical decision-making process. Planning of adjuvant therapy without such an assessment is imprecise. Intraoperative evaluation of extent of the neoplastic process is much more precise than assessment based on imaging studies or clinical criteria of staging, promoted by some centers. An increasing number of centers consider lymphadenectomy as an indispensable component of endometrial cancer management – according to present-day standards, reliable staging of endometrial cancer requires excision and study of lymph nodes. More extensive procedure is not associated with significant increase of complication rate, while reduces number of patients requiring radiotherapy, affecting favorably the patients’ quality of life. Patients undergoing pelvic and periaortic lymphadenectomy benefit from a longer recurrence-free survival and overall survival. Most frequent complication of these procedures is intraoperative bleeding, thromboembolic events and lymphocele. Favorable effects of a more extensive procedure are seen mainly in centers specialized in gynecologic oncology, where median number of excised pelvic and periaortic lymph nodes is significantly higher.

Słowa kluczowe
endometrial cancer, surgery, lymphadenectomy, postoperative complications, radiotherapy