STAGING LAPAROTOMY FOR ENDOMETRIAL CARCINOMA - ASSESSMENT OF RETROPERITONEAL LYMPH-NODES
STAGING LAPAROTOMY FOR ENDOMETRIAL CARCINOMA - ASSESSMENT OF RETROPERITONEAL LYMPH-NODES
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DOI：
10.1006/gyno.1995.1208
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发表时间：
1995-08-01
影响因子：
4.7
通讯作者：
GERSHENSON, DM
中科院分区：
文献类型：
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作者：
CHUANG, L;BURKE, TW;GERSHENSON, DM
国际妇产科联合会于1988年采用的子宫体癌手术分期方案将肿瘤扩散至腹膜后淋巴结的患者定为IIIC期。然而，一个推荐的方法来检测淋巴结转移没有划定。作为一个正在进行的项目，以评估手术分期程序的价值的一部分，我们回顾了295例高危患者的淋巴结评估技术。病例包括临床I期患者，术前活检显示2级或3级腺癌或乳头状浆液性、透明细胞或混合癌。我们将腹膜后间隙任意分为10个淋巴区：左右主动脉旁、髂总动脉、髂外动脉、腹下动脉和闭孔动脉。82%的患者有某种类型的节点采样，平均涉及三个区域。33/244例（13.5%）有淋巴结转移：20例大体受累，13例镜下受累。我们将患者分为三组：（1）未进行淋巴结取样的患者（n = 51），（2）进行了一些淋巴结活检的患者（n = 193），以及（3）淋巴结取样包括至少一个主动脉旁加至少一个左右盆腔标本的患者（n = 51）。在每组的“淋巴结阴性”患者中确定了被认为起源于淋巴结部位的腹膜后复发：第1组，4/51（8%）;第2组，9/173（5%）;第3组，0/38（0%）。在33例活检证实转移的患者中，8例（24%）出现淋巴结转移。我们发现，未能系统地采集盆腔和腹主动脉旁淋巴结样本会导致一个小的，但真实的，未被发现的子宫外转移的风险。一种选择性的取样方法，包括从主动脉旁和双侧盆腔淋巴区进行活检，似乎可以提供真实淋巴结阴性的准确估计。需要对这一办法作进一步评价。(C)出版社：Academic Press
The surgical staging scheme for uterine corpus cancer adopted in 1988 by the International Federation of Gynecology and Obstetrics assigns patients with tumor spread to retroperitoneal lymph nodes to stage IIIC. However, a recommended approach to the detection of lymph node metastasis is not delineated. As part of an ongoing project to assess the value of surgical staging procedures, we reviewed the techniques of lymph node evaluation in 295 at-risk patients. Cases included clinical stage I patients whose preoperative biopsies demonstrated grade 2 or 3 adenocarcinoma or papillary serous, clear cell, or mixed carcinoma. We arbitrarily divided the retroperitoneal space into 10 lymphatic zones: left and right para-aortic, common iliac, external iliac, hypogastric, and obturator. Eighty-two percent of patients had some type of node sampling that involved a mean of three zones. Thirty-three of 244 sampled cases (13.5%) had nodal metastases: 20 had gross involvement and 13 had microscopic. We stratified patients into three groups: (1) those who had no node sampling (n = 51), (2) those with some nodes biopsied (n = 193), and (3) those whose node sampling included a minimum of one para-aortic plus at least one right and left pelvic specimen (n = 51). Retroperitoneal recurrences thought to originate from lymph node sites were identified for the ''node-negative'' patients in each group: Group 1, 4/51 (8%); Group 2, 9/173 (5%); and Group 3, 0/38 (0%). Lymphatic site failures were seen in 8 of 33 (24%) patients with biopsy-proven metastases. We found that failure to systematically sample pelvic and para-aortic nodes results in a small, but real, risk of undetected extrauterine metastasis. A selective approach to sampling that includes biopsy from both para-aortic and bilateral pelvic lymphatic zones appears to provide an accurate estimate of true node negativity. Further evaluation of this approach is warranted. (C) 1995 Academic Press, Inc.