Impact of lymphadenectomy in patients with locally recurrent or persistent cervical cancer treated with salvage hysterectomy
Impact of lymphadenectomy in patients with locally recurrent or persistent cervical cancer treated with salvage hysterectomy
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DOI：
10.1111/jog.15495
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发表时间：
2022-11-16
影响因子：
1.6
通讯作者：
Kimura, Tadashi
中科院分区：
文献类型：
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作者：
Mabuchi, Seiji;Komura, Naoko;Kimura, Tadashi
目的探讨淋巴结清扫术（LND）在局部复发或持续性宫颈癌患者保留性子宫切除术中的作用。方法对局部复发或持续性宫颈癌行保留性子宫切除术的患者，包括有无LND。根据淋巴结转移的放射学证据将患者分为两组，并通过评估术后生存率来研究LND的影响。结果72例患者中，48例无淋巴结转移（第1组），24例有淋巴结转移（第2组）。总的来说，在挽救性子宫切除术中增加LND导致术后并发症增加。在第1组中，挽救性子宫切除术联合LND导致5例淋巴结假阴性（19.2%），但在术后生存率方面与单纯挽救性子宫切除术相比没有优势。在第2组中，所有患者均接受了LND，结果发现8例假阳性淋巴结（33.3%），术后生存期相当长。本组术后3年生存率为39.7%。结论保留性子宫切除术中包括LND可实现精确的淋巴结分期，但增加了术后并发症的风险。然而，考虑到不能提高生存率，LND不应该在没有淋巴结转移的放射学证据的患者的挽救性子宫切除术中进行。在有淋巴结转移的放射学证据的患者中，只有那些了解术后并发症风险和支持其生存优势的有限证据的患者才能进行挽救性子宫切除术加LND。
Aim To investigate the role of lymphadenectomy (LND) in locally recurrent or persistent cervical cancer patients treated with salvage hysterectomy. Methods Locally recurrent or persistent cervical cancer patients treated with salvage hysterectomy, with or without LND, were identified. Patients were divided into two groups according to the status of radiologic evidence of lymph node metastasis, and the impact of LND was investigated by evaluating postoperative survival. Results This study included 72 patients; 48 did not show radiological evidence of lymph node metastasis (Group 1) while 24 did (Group 2). Overall, the addition of LND to salvage hysterectomy resulted in increased postoperative complications. In Group 1, salvage hysterectomy plus LND resulted in the identification of five cases with false-negative lymph nodes (19.2%), but showed no advantage over salvage hysterectomy alone in terms of postoperative survival. In Group 2, all patients underwent LND, which resulted in the identification of eight cases with false-positive nodes (33.3%), and reasonably long postoperative survival. The estimated 3-year postoperative survival rate in this group was 39.7%. Conclusion Including LND in salvage hysterectomy allows for precise lymph node staging but increases risk of postoperative complications. However, considering the inability to improve survival, LND should not be performed during salvage hysterectomy in patients without radiological evidence of lymph node metastasis. In patients with radiological evidence of lymph node metastasis, salvage hysterectomy plus LND can only be performed in those who understand the risk of postoperative complications and the limited evidence supporting its survival advantage.