外阴癌淋巴结切除适应证和争议

外阴局部广泛切除术+腹股沟淋巴结切除术是目前外阴癌的基本手术方式。FIGO和NCCN指南均推荐FIGOⅠA期可不行腹股沟淋巴结切除术,所有ⅠB期或Ⅱ期患者,应该行腹股沟淋巴结切除术。晚期外阴癌在确定总体治疗方案前,应先明确腹股沟淋巴结状态,再确定后续处理方案。如果术前未发现可疑转移淋巴结,行双侧腹股沟、股淋巴结切除术;术前已明确淋巴结阳性者,建议仅切除肿大的淋巴结,术后给予腹股沟和盆腔放疗,最好避免系统性淋巴结切除术。在有关淋巴结切除的争议中,切除腹股沟、股淋巴结及采用三切口腹股沟横切口技术、保留大隐静脉等被大多数学者认可;但对于靠近中线但不侵犯中线的病灶是否可不切除双侧腹股沟淋巴结及外阴黑色素瘤、前庭大腺癌等少见病理类型的淋巴结切除指征尚有争议。     

卵巢癌淋巴结切除适应证和争议

手术是治疗卵巢癌的主要手段及重要基石。初次手术的彻底性与预后密切相关。淋巴结转移是卵巢癌常见的转移方式,也是评价早晚期的重要指标。尽管淋巴结切除在卵巢癌手术中具有重要地位,但仍具有一些争议。文章就卵巢癌淋巴结切除的适应证及争议予以总结。     

子宫内膜癌淋巴结切除适应证和争议

早期子宫内膜癌有淋巴转移风险,但是否对所有患者均需行区域淋巴结切除仍有争议。可根据术前、术中的评估决定是否行淋巴结切除及何种范围的淋巴结切除。高危病例应该实施系统性淋巴结切除。     

再议妇科恶性肿瘤淋巴结切除适应证与争议

<正>区域淋巴结切除作为实体瘤手术的组成部分,历史久远,但也争议不断。争议之点无外乎做与不做?孰大孰小?妇科恶性肿瘤起源于女性生殖器官,组织类型繁多,解剖部位各异,各类肿瘤淋巴结切除的适应证自然不同。随着对各类肿瘤生物学行为和淋巴系统生理功能认识的不断深入,重新审视淋巴结切除的初衷和适应证,对弥合分歧、指导临床实践应有所裨益。1恶性肿瘤区域淋巴结切除的初衷与历史人类最早认识淋巴系统在恶性肿瘤转移过程     

宫颈癌手术盆腹腔淋巴结切除相关问题

盆腹腔淋巴结切除是宫颈癌手术治疗的重要组成部分。如何评判盆腔淋巴结切除是否彻底？哪些患者需要腹主动脉旁淋巴结切除？前哨淋巴结在宫颈癌治疗中的作用？这些是当今宫颈癌淋巴结切除面临的问题,文章就以上问题进行讨论。     

宫颈癌前哨淋巴结的研究进展

前哨淋巴结能准确预测盆腔淋巴结的转移状态，应用生物活性染料法、放射性核素示踪法或两者联合应用对前哨淋巴结进行定位，通过细胞印记法、病理连续切片、免疫组织化学染色及RT-PCR技术检测提高其阳性检出率，特别是宫旁淋巴结，有利于制定宫颈癌患者个体化治疗方案。目前快速准确检出前哨淋巴结有待于进一步发展。     

前哨淋巴结与宫颈癌

前哨淋巴结是原发肿瘤区域淋巴引流的第一站,是最早发生肿瘤转移的部位。前哨淋巴结定位有染料法、核素法、联合法3种方法,对前哨淋巴结进行病理连续切片和免疫组织化学染色提高了微小转移灶的检出率,进而能有效判断淋巴结的转移情况。前哨淋巴结在宫颈癌的应用尚处在起步阶段。     

宫颈癌前哨淋巴结定位和检测

目的:使用亚甲蓝作为示踪剂检测宫颈癌前哨淋巴结,观察其安全性和可行性。方法:2006年3月至2007年3月,采用亚甲蓝检测25例ⅠB~ⅡB期宫颈癌前哨淋巴结。根据术后病理判断用前哨淋巴结预测盆腔淋巴结转移的准确性和假阴性率。结果:25例中,19例成功定位出前哨淋巴结36枚,总检出率为76.00%。最多见检出部位为闭孔淋巴结。准确率为100.00%,假阴性率为0。结论:染料法宫颈癌前哨淋巴结定位是安全可行的,检出部位以闭孔窝最多见。     

早期宫颈癌前哨淋巴结及其微转移研究

淋巴结转移是宫颈癌肿瘤细胞转移的最早特征,宫颈癌患者局部淋巴结状况直接影响患者的预后并决定着辅助治疗方案的制定。然而对患者盆腔所有淋巴结进行评估是一件十分繁杂的事情,前哨淋巴结(SLN)能反映整个盆腔淋巴结的转移状况,其研究使大多数早期宫颈癌患者避免不必要的盆腔淋巴结清扫术。目前常用的淋巴结识别方法有染料法、放射性核素示踪法及联合法。淋巴结微转移检测法(如:免疫组化法、连续切片法、鳞状细胞癌抗原检测及淋巴结HPV检测法等)能提高SLN的诊断准确性。     

子宫内膜癌腹膜后淋巴结切除的现状与争议

子宫内膜癌以手术治疗为主,腹膜后淋巴结切除是其全面分期手术不可或缺的内容之一。淋巴结转移与否不仅是子宫内膜癌手术病理分期的重要依据,也是指导术后辅助治疗和判断患者预后的重要参考。目前关于腹膜后淋巴结,尤其是腹主动脉旁淋巴结的切除是否作为子宫内膜癌手术治疗的常规内容,国内外各规范指南及临床实践中都有较大争议。本文就子宫内膜癌腹膜后淋巴结切除的现状与争议进行文献综述,以期为临床实践提供参考和指引。     

Pattern of lymph node metastasis and the optimal extent of pelvic lymphadenectomy in FIGO stage IB cervical cancer

AIM: To evaluate the distribution pattern of lymph node metastasis and to determine the optimal extent of pelvic lymphadenectomy (LA) in FIGO stage IB cervical cancer. METHODS: The medical records of 187 patients with FIGO stage IB cervical cancer from March 1996 to December 2002 were reviewed retrospectively. The distribution pattern and risk factors of lymph node metastases were analyzed in 31 patients with lymph node metastases confirmed surgically. One hundred patients, who underwent type III hysterectomy with pelvic LA but did not receive any adjuvant treatment, were analyzed to evaluate whether the extent of LA affected the prognosis of FIGO stage IB cervical cancer. Type I LA included the external iliac nodes, hypogastric nodes, obturator nodes, and parametrial nodes. Type II LA included the pelvic nodes described in type I LA, the common iliac nodes, gluteal nodes, deep inguinal nodes and sometimes the presacral nodes. RESULTS: Solitary lymph node metastasis confined to one node group was seen in the obturator, external iliac or hypogastric lymph nodes. All patients with lymph node metastases at multiple sites had metastasis in at least one of these lymph-node groups. There was no significant difference in disease-free survival and overall survival in patients without pathologic high-risk factors according to the type of pelvic LA. CONCLUSION: The extent of LA should be adjusted to reduce complications and not to affect adversely the prognosis of FIGO stage IB cervical cancer patients without pathologic high-risk factors.     

Pelvic lymphadenectomy for cervical cancer: extraperitoneal versus laparoscopic approach

OBJECTIVE: To compare the extraperitoneal versus the laparoscopic technique in performing pelvic lymphadenectomy in a series of patients undergoing a radical vaginal hysterectomy for locally advanced cervical cancer. STUDY DESIGN: Retrospective study with 42 patients undergoing a radical vaginal hysterectomy for cervical cancer. Patients from group A (20 patients) had a laparoscopic lymph node dissection and patients belonging to group B (22 patients) had an extraperitoneal lymphadenectomy. Historical data, clinical and surgical characteristics, perioperative and post-operative complications were analyzed. Follow-up was conducted according to the oncologic requirements. RESULTS: No significant difference was observed between the two groups in terms of blood loss, post-operative pain, transfusions, hospital stay and post-operative hematomas. The extraperitoneal group (group B) significantly showed a reduced operating time, a greater number of nodes removed (p<0.05). The only lymphocyst occurred in group B. CONCLUSIONS: Extraperitoneal pelvic lymphadenectomy can be considered an adequate technique to complement radical vaginal operations for cervical cancer.     

早期宫颈癌淋巴结转移规律的临床研究

目的 研究早期宫颈癌盆腔淋巴结转移的危险因素及规律,为其选择性淋巴结切除术和术后个性化放疗临床靶体积(clinical target volume,CTV)的勾画提供依据.方法 回顾性分析2009年1月至2015年12月湖南省肿瘤医院收治的7472例接受宫颈癌根治术的早期(Ⅰ A1～ⅡA2)宫颈癌患者的临床资料.结果 ...     

Pelvic lymphadenectomy in high risk endometrial cancer

Two hundred and thirty-eight out of a total of 1012 patients with 'high risk' endometrial cancer underwent a complete pelvic lymphadenectomy. When the disease was confined to the corpus, the rate of node positivity was 7%, when the cervix was involved it was 22% and with adnexal involvement was 52%. The recurrence rate with negative nodes was 14% compared to 45% with positive nodes. Age, menopausal status, histology and depth of invasion were predictors of survival after stratification by node status. Node status had no significant influence on site of recurrence. Women who underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy (TAH-BSO) and pelvic lymphadenectomy followed by vaginal vault brachytherapy had a similar cancer-free survival to those treated by TAH-BSO alone, followed by adjuvant megavoltage therapy and vaginal vault brachytherapy.     

Indications for primary and secondary exenterations in patients with cervical cancer

OBJECTIVE: Fifty years after the introduction of exenterative surgery in gynecologic oncology, the indication for primary and secondary exenteration is controversially discussed in cervical cancer patients. In addition, the term "palliative exenteration" is not precisely defined. We evaluate the role of primary exenteration in patients with stage IVA cervical cancer and the role of secondary palliative exenteration. METHODS: The study retrospectively analyzed surgical and oncologic data of 55 patients who underwent exenterative surgery in the Department of Gynecology at the University of Jena between February 1998 and January 2004. Primary surgery was performed in 20 patients with laparoscopically confirmed stage IVA cervical cancer, while 35 patients with recurrent cervical cancer underwent secondary exenteration. Fifty-one had total, 3 posterior and 1 anterior exenteration. Survival was analyzed in relation to the patient's age, indication (primary versus secondary, curative versus palliative), previous therapy (operation, radiation, chemotherapy, radiochemotherapy), histology, resection margins, pelvic nodal involvement, time interval from primary therapy to recurrence, type of exenteration and adjuvant therapy. Early and late postoperative complications as well as perioperative mortality were reviewed. RESULTS: The overall cumulative survival of all patients after exenteration was 36.8% at 5 years with 52.5% in the primary group and 26.7% in the recurrent one (p=0.0472). Complications were noted in 56.9% of patients, most commonly fistulas or gastrointestinal complications. Operative mortality was 5.5%. Survival correlated significantly with the time interval between primary treatment and recurrence (within 1-2 years 16.8% five-year survival, 2-5 years 28%, >5 years 83.2%, p=0.0105) as well as with curative or palliative intention (2-year survival rate of 60% in patients with curative intent, 10.5% in those with palliative intent, p=0.0001) and with tumor-free resection margins (2-year survival of 10.2% for positive margins, 5-year survival of 55.2% for negatives ones, p=0.0057). The age, the type of exenteration, the histologic type and the metastatic spread to pelvic lymph nodes had no significant influence on long-term survival. CONCLUSION: In patients with histopathologically confirmed stage IVA cervical cancer primary, exenteration is a valid alternative to primary chemoradiation. In patients with persistent or recurrent tumor limited to the pelvis, secondary exenteration should be offered in the absence of other therapeutic options. Palliative and curative attempts can best be differentiated by the resection margin status.