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Clark C, Loizzi V, Cormio G, Lopez S. Sentinel Lymph Node Assessment in Endometrial Cancer: A Review. Cancers (Basel) 2024; 16:3202. [PMID: 39335173 PMCID: PMC11430083 DOI: 10.3390/cancers16183202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2024] [Revised: 09/14/2024] [Accepted: 09/18/2024] [Indexed: 09/30/2024] Open
Abstract
As the number of patients diagnosed with endometrial cancer rises, so does the number of patients who undergo surgical treatment, consisting of radical hysterectomy, bilateral salpingo-oophorectomy, and bilateral pelvic lymphadenectomy or lymph node sampling. The latter entail intra- and post-surgical complications, such as lymphedema and increased intra-operative bleeding, which often outweigh their benefits. Sentinel Lymph Node (SLN) sampling is now common practice in surgical management of breast cancer, as it provides important information about the disease without jeopardizing surgical radicality and patient outcomes. While this technique has also been shown to be feasible in patients with endometrial cancer, there is little consensus on several aspects, such as tracer injection volume and site, pathological ultrastaging, and result interpretation. The aim of this review is to analyze the current literature on SLN assessment in order to help standardize the procedure.
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Affiliation(s)
- Christopher Clark
- Azienda Ospedaliera Universitaria "Policlinico di Bari"-Clinica di Ginecologia e Ostetricia, 70124 Bari, Italy
| | - Vera Loizzi
- Azienda Ospedaliera Universitaria "Policlinico di Bari"-Clinica di Ginecologia e Ostetricia, 70124 Bari, Italy
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Gennaro Cormio
- Azienda Ospedaliera Universitaria "Policlinico di Bari"-Clinica di Ginecologia e Ostetricia, 70124 Bari, Italy
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
| | - Salvatore Lopez
- Gynecologic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", 70124 Bari, Italy
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Şimşek E, Gündüz S, Yıldız ÖA, Serhanoğlu Z, Yaşar L. Robotic sentinel lymph node dissection experiences in endometrial cancer at our tertiary cancer treatment institution. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2024; 70:e20240696. [PMID: 39292092 DOI: 10.1590/1806-9282.20240696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2024] [Accepted: 06/05/2024] [Indexed: 09/19/2024]
Abstract
OBJECTIVE In endometrial cancer surgery, sentinel lymph node dissection is used instead of staging surgery, particularly in advanced disease that is limited to the uterus. The aim of this study is to evaluate our practice of robotic sentinel lymph node dissection, which is applied to endometrial cancer patients in our tertiary cancer treatment center, according to the current literature, and to share our own data. METHODS Included in our analysis are patients who underwent robotic sentinel lymph node dissection for endometrial cancer utilizing indocyanine green in our center between January 2018 and January 2024. RESULTS In all, of the 93 endometrial carcinoma patients who underwent sentinel lymph node biopsy, 63 were classified as low-risk, while 30 were high-risk according to the European Society of Gynaecological Oncology and National Comprehensive Cancer Network guidelines. We found sentinel lymph nodes in both low-risk and high-risk patients, with an overall sensitivity of 96.32% (95% confidence interval [CI], 85.12-99.71), specificity of 100% (95%CI, 92.20-99.8), negative predictive value of 96.72% (95%CI, 87.03-99.89), and negative likelihood ratio of 0.06 (95%CI, 0.01-0.36). CONCLUSION After evaluating our data retrospectively, we determined that we were compatible with the current literature.
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Affiliation(s)
- Erkan Şimşek
- University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - İstanbul, Turkey
| | - Sadık Gündüz
- University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - İstanbul, Turkey
| | - Özge Akdeniz Yıldız
- University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - İstanbul, Turkey
| | - Zinar Serhanoğlu
- Kırıkhan State Hospital, Gynecology and Obstetrics Clinic - Antakya, Turkey
| | - Levent Yaşar
- University of Health Sciences Turkey, Bakırköy Dr. Sadi Konuk Training and Research Hospital, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology - İstanbul, Turkey
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Matak L, Šimičević M, Dukić B, Matak M, Baekelandt J. vNOTES surgical staging for endometrial carcinoma in overweight patients: a case series. Arch Gynecol Obstet 2024; 309:2829-2832. [PMID: 38578545 DOI: 10.1007/s00404-024-07466-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Accepted: 03/04/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES The purpose of this study is to show the feasibility and surgical outcome of vNOTES retroperitoneal dissection and isolation of sentinel lymph nodes in overweight and obese patients with endometrial cancer. MATERIALS AND METHODS Four patients had undergone pelvic lymphadenectomy with a sentinel lymph node. Three patients were overweight, and one was obese with a BMI of 34.6 kg/m2. By using NMR mode sentinel lymph node was visualized, excised and marked separately for pathohistological analysis from the rest of the visualized lymph nodes that were then consecutively excised. RESULTS The mean number of overall excised lymph nodes was 12.5, and the mean number on the right side was 5.75 and 6.25 on the left side. There were no metastases verified in the pathohistological evaluation. CONCLUSION vNOTES retroperitoneal isolation of sentinel lymph nodes is good alternative and has its benefits, especially in overweight and obese patients with satisfying low intra- and postoperative complications.
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Affiliation(s)
- Luka Matak
- Department of Obstetrics and Gynecology, General Hospital Zadar, Bože Peričića 5, 23000, Zadar, Croatia.
| | - Maša Šimičević
- Department of Obstetrics and Gynecology, General Hospital Zadar, Bože Peričića 5, 23000, Zadar, Croatia
| | - Branko Dukić
- Department of Obstetrics and Gynecology, General Hospital Zadar, Bože Peričića 5, 23000, Zadar, Croatia
| | - Magdalena Matak
- Department of Dermatovenerology, General Hospital Zadar, Zadar, Croatia
| | - Jan Baekelandt
- Department of Obstetrics and Gynaecology, Imelda Hospital, Bonheiden, Belgium
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Ouasti S, Ilic J, Mimoun C, Bendifallah S, Huchon C, Ouldamer L, Lorenzini J, Lavoué V, Raimond E, Dion L, Costaz H, Dupre PF, Graesslin O, Uzan J, Kerbage Y, Chauvet P, Canlorbe G, Touboul C, Dabi Y. Adherence to ESGO guidelines and impact on survival in obese patients with endometrial cancer: a multicentric retrospective study. Int J Gynecol Cancer 2023; 33:1950-1956. [PMID: 37788899 DOI: 10.1136/ijgc-2023-004642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/05/2023] Open
Abstract
OBJECTIVES Obesity is known to be both a major risk factor for endometrial cancer and associated with surgical complexity. Therefore, the management of patients with obesity is a challenge for surgeons and oncologists. The aim of this study is to assess the adherence to European Society of Gynaecological Oncology (ESGO) guidelines in morbidly obese patients (body mass index (BMI) >40 kg/m2). The secondary objectives were the impact on overall survival and recurrence-free survival. METHODS All the patients who were treated for an endometrial cancer in the 11 cancer institutes of the FRANCOGYN group were included and classified into three weight groups: morbid (BMI >40 kg/m2), obese (BMI 30-40), and normal or overweight (BMI <30). Adherence to guidelines was evaluated for surgical management, lymph node staging, and adjuvant therapies. RESULTS In total, 2375 patients were included: 1330 in the normal or overweight group, 763 in the obese group, and 282 in the morbid group. The surgical management of the morbid group was in accordance with the guidelines in only 30% of cases, compared with 44% for the obese group and 48% for the normal or overweight group (p<0.001); this was largely because of a lack of lymph node staging. Morbid group patients were more likely to receive the recommended adjuvant therapy (61%) than the obese group (52%) or the normal or overweight group (46%) (p<0.001). Weight had no impact on overall survival (p=0.6) and morbid group patients had better recurrence-free survival (p=0.04). CONCLUSION Adherence to international guidelines for surgical management is significantly lower in morbid group patients, especially for lymph node staging. However, morbidly obese patients had more often the adequate adjuvant therapies. Morbid group patients had a better recurrence-free survival likely because of better prognosis tumors.
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Affiliation(s)
- Samia Ouasti
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Johanna Ilic
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Camille Mimoun
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Sofiane Bendifallah
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Cyrille Huchon
- Department of Gynaecology, Hospital Group Saint-Louis Lariboisiere and Fernand-Widal, Paris, France
| | - Lobna Ouldamer
- Department of Gynaecology, Hôpital Bretonneau, Tours, France
| | | | - Vincent Lavoué
- Department og Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Emilie Raimond
- Department of Gyneacology and Obstetrics, Reims Champagne-Ardenne University, Reims, France
| | - Ludivine Dion
- Department of Gynecology and Obstetrics, Rennes 1 University, Rennes, France
| | - Hélène Costaz
- Departement of Oncology Surgery, Georges-François Leclerc Centre, Dijon, France
| | | | - Olivier Graesslin
- Department of Obstetrics and Gynecology, Université de Reims Champagne-Ardenne, Reims, France
| | - Jennifer Uzan
- Department of Gynaecology and Obstetrics, Centre Hospitalier Intercommunal de Créteil (CHI Créteil), Créteil, France
| | | | - Pauline Chauvet
- Department of Gynaecology, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Geoffroy Canlorbe
- Department of Gynecological and Breast Surgery and Oncology, Hopitaux Universitaires Pitie Salpetriere-Charles Foix, Paris, France
| | - Cyril Touboul
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
| | - Yohann Dabi
- Department of Obstetrics Gynaecology and Reproductive Medicine, Sorbonne University - Tenon Hospital, Assistance Publique des Hôpitaux de Paris (AP-HP), Paris, France
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Lee PS, Brunette LL, Sriprasert I, Eloustaz M, Deshpande R, Adams C, Muderspach L, Roman L, Dickerson S, Kim MP. Benefits of the Enhanced Recovery After Surgery (ERAS) Pathway With Quadratus Lumborum Blocks for Minimally Invasive Gynecologic Surgery Patients: A Retrospective Cohort Study. Cureus 2023; 15:e49183. [PMID: 38130508 PMCID: PMC10733622 DOI: 10.7759/cureus.49183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/23/2023] Open
Abstract
STUDY OBJECTIVE This study aimed to determine the effect of the implementation of the Enhanced Recovery After Surgery (ERAS) protocol among patients receiving minimally invasive gynecologic surgery. DESIGN AND SETTING This retrospective cohort study was performed in a tertiary care hospital. PATIENTS A total of 328 females who underwent minimally invasive gynecologic surgeries requiring at least one overnight stay at Keck Hospital of University of Southern California (USC), California, USA, from 2016 to 2020 were included in this study. INTERVENTIONS The institutional ERAS protocol was implemented in late 2018. A total of 186 patients from 2016 to 2018 prior to the implementation were compared to 142 patients from 2018 to 2020 after the implementation. Intraoperatively, the ERAS group received a multimodal analgesic regimen (including bilateral quadratus lumborum (QL) blocks) and postoperative care geared toward a satisfactory, safe, and expeditious discharge. MEASUREMENTS AND MAIN RESULTS The two groups were similar in demographics, except for the shorter surgical time noted in the ERAS group. The median opioid use was significantly less among the ERAS patients compared with the non-ERAS patients on postoperative day 1 (7.5 vs. 14.3 mg; p<0.001) and throughout the hospital stay (17.4 vs. 36.2 mg; p<0.001). The ERAS group also had a shorter median hospital length of stay compared to the non-ERAS group (p<0.01). Among patients with a malignant diagnosis, patients in the ERAS group had significantly less postoperative day 1 and total opioid use and a shorter hospital stay (p<0.01). Within the ERAS group, 20% of the patients did not end up receiving a QL block. Opioid use and length of stay were similar between patients who did and did not receive the QL block. CONCLUSIONS The ERAS pathway was associated with a reduction in opioid use postoperatively and a shorter length of hospital stay after minimally invasive gynecologic surgery. There was a more significant decrease in opioid use and hospital length of stay for patients with malignant diagnoses compared to patients with benign diagnoses. Further research can be done to fully delineate the effect of QL blocks in ERAS protocols.
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Affiliation(s)
- Paul S Lee
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Laurie L Brunette
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Intira Sriprasert
- Obstetrics and Gynecology, Los Angeles County Medical Center and University of Southern California Medical Center, Los Angeles, USA
| | - Mohamed Eloustaz
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Rasika Deshpande
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Crystal Adams
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Laila Muderspach
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Lynda Roman
- Obstetrics and Gynecology, University of Southern California, Los Angeles, USA
| | - Shane Dickerson
- Anesthesiology, University of Southern California, Los Angeles, USA
| | - Michael P Kim
- Anesthesiology, University of Southern California, Los Angeles, USA
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Matanes E, Amajoud Z, Kogan L, Mitric C, Ismail S, Raban O, Knigin D, Levin G, Bahoric B, Ferenczy A, Pelmus M, Lecavalier-Barsoum M, Lau S, Salvador S, Gotlieb WH. Is sentinel lymph node assessment useful in patients with a preoperative diagnosis of endometrial intraepithelial neoplasia? Gynecol Oncol 2023; 168:107-113. [PMID: 36423445 DOI: 10.1016/j.ygyno.2022.10.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Revised: 10/22/2022] [Accepted: 10/28/2022] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the prevalence of underlying high-intermediate (high-IM) and high-risk endometrial cancer (EC) in patients with preoperative diagnosis of Endometrial intraepithelial neoplasia (EIN) and to assess the impact of the information retrieved from the sentinel lymph node (SLN) on adjuvant therapy. METHODS Retrospective cohort study of women undergoing hysterectomy, optional bilateral salpingo-oophorectomy (BSO) and lymph nodes assessment for EIN between December 2007 and August 2021. RESULTS One hundred and sixty two (162) eligible patients were included, of whom 101 (62.3%) had a final diagnosis of EIN, while 61 (37.7%) were ultimately diagnosed with carcinoma. Out of 15 patients with high-IM to high-risk disease (9.25% of all EIN), 12 had grade 2-3 EC including 8 with >50% myometrial invasion, 2 with serous subtype, 1 with cervical invasion and 2 with pelvic lymph nodes involvement. Of the 3 patients with grade 1 EC, one patient had disease involving the adnexa and 2 patients had tumor invading >50% of the myometrium and with lymphovascular space invasion (LVSI). Ten patients received vaginal brachytherapy after surgery, 3 patients with extrauterine spread were treated with systemic chemotherapy followed by vaginal brachytherapy and pelvic external-beam radiotherapy and 2 patients with early-stage serous carcinoma received chemotherapy followed by vaginal brachytherapy. CONCLUSIONS Information from SLN, even when negative, can be helpful in the management of patients with EC after preoperative EIN, as some patients are found to have high-IM to high-risk disease on final pathology. These patients would require either re-staging surgery or adjuvant external beam radiotherapy, both could be avoided by proper staging.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada; Department of Obstetrics and Gynecology, Rambam Medical Center, Technion, Haifa, Israel
| | - Zainab Amajoud
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Hebrew University, Jerusalem, Israel
| | - Cristina Mitric
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Sara Ismail
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oded Raban
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David Knigin
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Gabriel Levin
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Boris Bahoric
- Division of Radiation Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Alex Ferenczy
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Manuela Pelmus
- Department of Pathology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Magali Lecavalier-Barsoum
- Division of Radiation Oncology, Segal Cancer Center, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter H Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada; Segal Cancer Center, Lady Davis Institute of Medical Research, McGill University, Montreal, Quebec, Canada.
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7
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Applications and Safety of Sentinel Lymph Node Biopsy in Endometrial Cancer. J Clin Med 2022; 11:jcm11216462. [DOI: 10.3390/jcm11216462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 10/27/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022] Open
Abstract
Lymph node status is important in predicting the prognosis and guiding adjuvant treatment in endometrial cancer. However, previous studies showed that systematic lymphadenectomy conferred no therapeutic values in clinically early-stage endometrial cancer but might lead to substantial morbidity and impact on the quality of life of the patients. The sentinel lymph node is the first lymph node that tumor cells drain to, and sentinel lymph node biopsy has emerged as an acceptable alternative to full lymphadenectomy in both low-risk and high-risk endometrial cancer. Evidence has demonstrated a high detection rate, sensitivity and negative predictive value of sentinel lymph node biopsy. It can also reduce surgical morbidity and improve the detection of lymph node metastases compared with systematic lymphadenectomy. This review summarizes the current techniques of sentinel lymph node mapping, the applications and oncological outcomes of sentinel lymph node biopsy in low-risk and high-risk endometrial cancer, and the management of isolated tumor cells in sentinel lymph nodes. We also illustrate a revised sentinel lymph node biopsy algorithm and advocate to repeat the tracer injection and explore the presacral and paraaortic areas if sentinel lymph nodes are not found in the hemipelvis.
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Simon O, Dion L, Nyangoh Timoh K, Dupré PF, Azaïs H, Bendifallah S, Touboul C, Dabi Y, Graesslin O, Raimond E, Costaz H, Kerbage Y, Huchon C, Mimoun C, Koskas M, Akladios C, Lecointre L, Canlorbe G, Chauvet P, Ouldamer L, Levêque J, Lavoué V. Impact of severe obesity in the management of patients with high-risk endometrial cancer: A FRANCOGYN study. J Gynecol Obstet Hum Reprod 2022; 51:102429. [DOI: 10.1016/j.jogoh.2022.102429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2022] [Revised: 05/29/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
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9
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Matanes E, Eisenberg N, Mitric C, Yasmeen A, Ismail S, Raban O, Cantor T, Knigin D, Lau S, Salvador S, Gotlieb W, Kogan L. Surgical and oncological outcomes of sentinel lymph node sampling in elderly patients with intermediate to high-risk endometrial carcinoma. Int J Gynecol Cancer 2022; 32:875-881. [PMID: 35680137 DOI: 10.1136/ijgc-2022-003431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE We aimed to evaluate the surgical and oncological outcomes of elderly patients with intermediate to high-risk endometrial cancer undergoing staging with sentinel lymph node (SLN) sampling and pelvic lymphadenectomy. METHODS We conducted a retrospective study of elderly (>65-year-old) patients diagnosed with endometrial cancer between December 2007 and August 2017. These patients had been treated at a single center in Montreal, Canada. We compared the surgical and oncological outcomes of three cohorts undergoing surgical staging in non-overlapping eras: 1) lymphadenectomy, 2) lymphadenectomy and SLN sampling, 3) SLN sampling alone. Using life tables, Kaplan-Meier survival curves and log-rank tests, we analyzed 2-year progression-free survival, overall survival, and disease-specific survival. RESULTS Our study included 278 patients with a median age of 73 years (range; 65-91): 84 (30.2%) underwent lymphadenectomy, 120 (43.2%) underwent SLN sampling with lymphadenectomy, and 74 (26.6%) had SLN sampling alone. The SLN sampling alone group had shorter operative times with a median duration of 199 minutes (range, 75-393) compared with 231 (range, 125-403) and 229 (range, 151-440) minutes in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts; respectively (p<0.001). The SLN sampling alone group also had lower estimated blood loss with a median loss of 20 mL (range, 5-150) vs 25 mL (range, 5-800) and 40 mL (range, 5-400) in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts, respectively (p=0.002). The 2 year overall survival and progression-free survival were not significantly different between the three groups (p=0.45, p=0.51, respectively). On multivariable analysis after adjusting for age, American Society of Anesthesiologists (ASA) score, stage, grade, and lymphovascular space invasion, adding SLN sampling was associated with better overall survival, (HR 0.2, CI [0.1 to 0.6], p=0.006) and progression-free survival (HR 0.5, CI [0.1 to 1.0], p=0.05). CONCLUSION Sentinel lymph node-based surgical staging is feasible and associated with better surgical outcomes and comparable oncological outcomes in elderly patients with intermediate and high-risk endometrial cancer.
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Affiliation(s)
- Emad Matanes
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada .,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Neta Eisenberg
- Yitzhak Shamir Medical Center Assaf Harofeh, Zerifin, Center, Israel
| | - Cristina Mitric
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Amber Yasmeen
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Sara Ismail
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Oded Raban
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Tal Cantor
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - David Knigin
- Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Susie Lau
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Shannon Salvador
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Walter Gotlieb
- Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.,Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
| | - Liron Kogan
- Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
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Mandato VD, Palicelli A, Torricelli F, Mastrofilippo V, Leone C, Dicarlo V, Tafuni A, Santandrea G, Annunziata G, Generali M, Pirillo D, Ciarlini G, Aguzzoli L. Should Endometrial Cancer Treatment Be Centralized? BIOLOGY 2022; 11:768. [PMID: 35625496 PMCID: PMC9138425 DOI: 10.3390/biology11050768] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 05/17/2023]
Abstract
Endometrial cancer (EC) is the most common malignancy of the female genital tract in Western and emerging countries. In 2012, new cancer cases numbered 319,605, and 76,160 cancer deaths were diagnosed worldwide. ECs are usually diagnosed after menopause; 70% of ECs are diagnosed at an early stage with a favorable prognosis and a 5-year overall survival rate of 77%. On the contrary, women with advanced or recurrent disease have extremely poor outcomes because they show a low response rate to conventional chemotherapy. EC is generally considered easy to treat, although it presents a 5-year mortality of 25%. Though the guidelines (GLs) recommend treatment in specialized centers by physicians specializing in gynecologic oncology, most women are managed by general gynecologists, resulting in differences and discrepancies in clinical management. In this paper we reviewed the literature with the aim of highlighting where the treatment of EC patients requires gynecologic oncologists, as suggested by the GLs. Moreover, we sought to identify the causes of the lack of GL adherence, suggesting useful changes to ensure adequate treatment for all EC patients.
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Affiliation(s)
- Vincenzo Dario Mandato
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Andrea Palicelli
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
| | - Federica Torricelli
- Laboratory of Translational Research, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy;
| | - Valentina Mastrofilippo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Chiara Leone
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Vittoria Dicarlo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Alessandro Tafuni
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Pathology Unit, Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy
| | - Giacomo Santandrea
- Pathology Unit, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (A.P.); (A.T.); (G.S.)
- Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, 41121 Modena, Italy
| | - Gianluca Annunziata
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Matteo Generali
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Debora Pirillo
- Unit of Obstetrics and Gynecology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (V.M.); (C.L.); (V.D.); (G.A.); (M.G.); (D.P.)
| | - Gino Ciarlini
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
| | - Lorenzo Aguzzoli
- Unit of Surgical Gynecol Oncology, Azienda USL-IRCCS di Reggio Emilia, 42122 Reggio Emilia, Italy; (G.C.); (L.A.)
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Benbrook DM, Hocker JRS, Moxley KM, Hanas JS. Sera Protein Signatures of Endometrial Cancer Lymph Node Metastases. Int J Mol Sci 2022; 23:3277. [PMID: 35328698 PMCID: PMC8954239 DOI: 10.3390/ijms23063277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 12/10/2022] Open
Abstract
The presence of lymph node metastases in endometrial cancer patients is a critical factor guiding treatment decisions; however, surgical and imaging methods for their detection are limited by morbidity and inaccuracy. To determine if sera can predict the presence of positive lymph nodes, sera collected from endometrial cancer patients with or without lymph node metastases, and benign gynecology surgical patients (N = 20 per group) were subjected to electron spray ionization mass spectrometry (ES-MS). Peaks that were significantly different among the groups were evaluated by leave one out cross validation (LOOCV) for their ability to differentiation between the groups. Proteins in the peaks were identified by MS/MS of five specimens in each group. Ingenuity Pathway Analysis was used to predict pathways regulated by the protein profiles. LOOCV of sera protein discriminated between each of the group comparisons and predicted positive lymph nodes. Pathways implicated in metastases included loss of PTEN activation and PI3K, AKT and PKA activation, leading to calcium signaling, oxidative phosphorylation and estrogen receptor-induced transcription, leading to platelet activation, epithelial-to-mesenchymal transition and senescence. Upstream activators implicated in these events included neurostimulation and inflammation, activation of G-Protein-Coupled Receptor Gβγ, loss of HER-2 activation and upregulation of the insulin receptor.
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Affiliation(s)
- Doris Mangiaracina Benbrook
- Gynecologic Oncology Section, Department of Obstetrics and Gynecology, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - James Randolph Sanders Hocker
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
| | - Katherine Marie Moxley
- Department of Obstetrics and Gynecology, Rogel Cancer Center, University of Michigan Health System, Ann Arbor, MI 48109, USA;
| | - Jay S. Hanas
- Department of Biochemistry and Molecular Biology, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA;
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