Analysis of Sentinel Lymph Node Adoption Compared to Systematic Lymphadenectomy in Staging Early Endometrial Cancer at a Tertiary Center: An Ambispective Study.

IF 2 3区医学 Q3 ONCOLOGY

Journal of Surgical Oncology Pub Date : 2025-06-23 DOI:10.1002/jso.70008

Rodrigo Pinto Fernandes, Cristina Anton, Marilia Bertolazzi, Maria Luiza Genta, André Lopes, Rossana Veronica Mendonza Lopez, José Antônio Orellana Turri, Raphael Paschoalini, Ricardo Dos Reis, Arnaud Wattiez, Edmund Chada Baracat, Jesus Paula Carvalho

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引用次数: 0

Abstract

Objective: The purpose of this study was to assess the impact of changing endometrial carcinoma staging from systematic lymph node dissection to the sentinel lymph node approach.

Methods: This is an ambispective study including patients with endometrial carcinoma (EC) limited to the uterus (FIGO 2018 IA/IB). From December 2015 to October 2021, a group of patients underwent systematic staging with lymph node dissection (LND). From December 2021 to April 2024, another group of patients underwent surgical staging with the sentinel lymph node-indocyanine green (SLN) algorithm and pathology ultrastaging analisys. The groups were matched (1 LND: 1 SLN) based on age, body mass index (BMI), tumor type, tumor size, and myometrial invasion. The primary endpoints were lymph node involvement, length of surgery, and complications. Complications were classified according to the Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results: Two hundred fifty-seven patients were surgically treated during the study period (156 in the LND cohort, 101 in the SLN cohort). Propensity score matching revealed two equivalent groups containing 84 patients each. The rate of positive lymph nodes was similar between the LND group (3.6%) and the SLN group (8.3%) (OR: 2.46, 95% CI: 0.61-9.84; p = 0.205). The length of surgery was significantly lower in the SLN group (152.2 ± 51.9 min) compared to the LND group (304 ± 77.8 min) (p < 0.001). Intraoperative blood loss greater than 100 mL was significantly lower in the SLN group (9.5%) compared to the LND group (29.8%) (p < 0.001). CTCAE grades requiring intervention (grades 3, 4, and 5) were higher in the LND group (14.3%) compared to the SLN group (4.8%) (p = 0.049).

Conclusion: The transition from LND to SLN approach was similar compared to systematic lymphadenectomy, allowing the reduction of surgical length, blood loss and severity of complications without compromising surgical complications and lymph node positivity.

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前哨淋巴结采用与系统淋巴结切除术在三级中心分期早期子宫内膜癌中的比较：一项双镜研究。

目的：本研究的目的是评估改变子宫内膜癌分期从系统淋巴结清扫到前哨淋巴结入路的影响。方法：这是一项双镜研究，包括局限于子宫的子宫内膜癌（EC）患者（FIGO 2018 IA/IB）。2015年12月至2021年10月，一组患者进行了系统分期淋巴结清扫（LND）。2021年12月至2024年4月，另一组患者采用前哨淋巴结-吲哚菁绿（SLN）算法进行手术分期和病理超移分析。根据年龄、体重指数（BMI）、肿瘤类型、肿瘤大小和子宫肌层浸润情况进行配对（1 LND: 1 SLN）。主要终点是淋巴结受累、手术时间和并发症。根据不良事件通用术语标准（CTCAE） v5.0对并发症进行分类。结果：257例患者在研究期间接受了手术治疗（LND组156例，SLN组101例）。倾向评分匹配显示两个相等的组，每组84例患者。LND组（3.6%）和SLN组（8.3%）的淋巴结阳性率相似(OR: 2.46, 95% CI: 0.61-9.84；p = 0.205)。与LND组（304±77.8 min）相比，SLN组的手术时间（152.2±51.9 min）明显缩短(p)。结论：从LND到SLN的过渡与系统淋巴结切除术相似，可以减少手术时间、出血量和并发症的严重程度，而不会影响手术并发症和淋巴结阳性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Surgical Oncology 医学-外科

CiteScore

4.70

自引率

4.00%

发文量

367

审稿时长

2 months

期刊介绍： The Journal of Surgical Oncology offers peer-reviewed, original papers in the field of surgical oncology and broadly related surgical sciences, including reports on experimental and laboratory studies. As an international journal, the editors encourage participation from leading surgeons around the world. The JSO is the representative journal for the World Federation of Surgical Oncology Societies. Publishing 16 issues in 2 volumes each year, the journal accepts Research Articles, in-depth Reviews of timely interest, Letters to the Editor, and invited Editorials. Guest Editors from the JSO Editorial Board oversee multiple special Seminars issues each year. These Seminars include multifaceted Reviews on a particular topic or current issue in surgical oncology, which are invited from experts in the field.