Prognostic and therapeutic importance of lymphadenectomy in gynecological cancers

Lymphadenectomy has been a matter of interest for years because of the increased morbidity rates in gynecological cancers due to the procedure itself and because the procedure requires experience. Although a number of alternative methods have been developed to find out the prevalence of gynecological cancers, dissection and histopathological evaluation of lymph nodes is still the gold standard in detecting disease. Even though there are opposing views regarding this approach, since the morbidity rate has decreased over the years many studies in the literature report that lymphadenectomy has prognostic and therapeutic value. Its contribution to survival can be attributed both to its being determinant in postoperative treatment modifications and to debulking and lymphadenectomy itself. In order to reap the prognostic and therapeutic benefit expected from lymphadenectomy, a sufficient number of lymph nodes must be dissected. Surgical experience is important both for the procedure itself and to reduce the morbidity due to the procedure. This study discusses the prognostic and therapeutic importance of lymphadenectomy in ovarian, endometrial, cervical and vulvar cancers.

Lymphadenectomy; Prognostic; Therapeutic; Ovarian cancer; Endometrial cancer; Cervical cancer; Vulvar cancer

[1] Kupets R., Thomas G.M., Covens A.: "Is there a role for pelvic lymph node debulking in advanced cervical cancer?". Gynecol Oneal., 2002, 87, 163.

[2] Petru E., Lahousen M., Tamussino K., Pickel H., Stettner H.: "Prognostic implications of residual tumour volume in stage III ovarian cancer patients undergoing呻uvant cytotoxic chemotherapy". Baillieres Clin. Obstet. Gynaecol., 1989, 3, 109.

[3] Downey G.O., Potish R.A., Adcock LL., Prem K.A., Twiggs L.B.: "Pretreatment surgical staging in cervical carcinoma: therapeutic efficacy of pelvic lymph node resection". Am. J. Obstet. Gynecol., 1989, 160, 1055.

[4] Ayhan A., Taskiran C., Celik C., Guney I., Yuce K., Ozyar E. et al.: "Is there a survival benefit to adjuvant radiotherapy in highrisk surgical Stage I endometrial cancer?'. Gynecol. Oneal., 2002, 86, 259.

[5] Panici P.B., Angioli R.: "Role of lymphadenectomy in ovarian cancer". Best. Pract. Res. Clin. Obstet. Gynaecol., 2002, 16, 529.

[6] Mangan C.E., Rubin S.C., Rabin D.S., Mikuta J.J.: "Lymph node nomenclature in gynecologic oncology". Gynecol. Oneal., 1986, 23, 222.

[7] Nicklin J.L., Hacker N.F., Heintze S.W., Van Eijkeren M., Durham N.J.: "An anatomical study of inguinal lymph node topography and clinical implications for the surgical management of vulval cancer". Int. J. Gynecol. Cancer, 1995, 5, 128.

[8] Benedetti-Panici P., Maneschi F., Cutillo G.: "Pelvic and aortic lymphadenectomy". Surg. Clin. North Am., 2001, 81, 841.

[9] Wolfson A.H., Sightler S.E., Markoe A.M., Schwade J.G., Averette H.E., Ganjei P., Hilsenbeck S.G.: "The prognostic significance of surgical staging for carcinoma of the endometrium". Gynecol. Oneal., 1992, 45, 142.

[10] DiSaia P.J., Creasman WT.: "Adenocarcinoma of the Uterus. Clinical Gynecologic Oncology" (6th ed.), Mosby 2001, 134.

[11] Guidelines for referral to a gynecologic oncologist: rationale and benefits: "The Society of Gynecologic Oncologists". Gynecol Oneal., 2000, 78, S1.

[12] Creasman W.T., Morrow C.P., Bundy B.N., Homesley H.D., Graham J.E., Heller P.B.: "Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study". Cancer, 1987, 60, 2035.

[13] Kucera E., Kainz C., Reinthaller A., Sliutz G., Leodolter S., Kucera H., Breitenecker G.: "Accuracy of intraoperative frozen-section diagnosis in stage I endometrial adenocarcinoma". Gynecol. Obstet. Invest., 2000, 49, 62.

[14] Kayikcioglu F., Boran N., Meydanli M.M., Tulunay G., Kose F.M., Bulbul D.: "Is frozen-section diagnosis a reliable guide in surgical treatment of Stage I endometrial carcinoma?". Acta Oneal., 2002, 41, 444.

[15] Boronow R.C., Morrow C.P., Creasman W.T., Disia P.J., Silverberg S.G., Miller A., Blessing J.A.: "Surgical staging in endometrial cancer: clinical-pathologic findings of a prospective study". Obstet. Gynecol., 1984, 3, 825.

[16] Creasman W.T., Boronow R.C., Morrow C.P., DiSaia P.J., Blessing J.: "Adenocarcinoma of the endometrium: its metastatic lymph node potential. A preliminary report". Gynecol. Oneal., 1976, 4, 239.

[17] Hncak H.，Rubmstem L.v.，Gherman GM.，Karstaedt N.： “MR, imagmg evaluation of endometrial carcmoma: results of an NCI cooperative study". Radiology, 1991, 179, 829.

[18] Chuang L., Burke T.W., Tornos C., Marino B.D., Mitchell M.F., Tortolero-Luna G. et al.: "Staging laparotomy for endometrial carcinoma: assessment of retroperitoneal lymph nodes". Gynecol. Oncol., 1995, 58, 189.

[19] Mariani A., Webb M.J., Galli L., Podratz K.C.: "Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer". Gynecol. Oncol., 2000, 76, 348.

[20] Kilgore LC., Partridge E.E., Alvarez R.D., Austin J.M., Shingleton H.M., Noojin F. 3'd, Conner W.: "Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling". Gynecol. Oneal., 1995, 56, 29.

[21] Ayhan A., Tuncer Z.S., Tuncer R., Yuce K., Kucukali T.: "Tumor status of lymph nodes in early endometrial cancer in relation to lymph node size". Eur. J. Obstet. Gynecol. Reprod. Biol., 1995, 60, 61.

[22] Committee on Practice Bulletins-Gynecology. ACOG Practice Bulletin: Diagnosis and treatment of cervical carcinomas, no. 35, May 2002. Obstet. Gynecol., 2002, 99, 855.

[23] Makar A.P., Trope C.: "F ertility preservation in gynecologic cancer". Acta Obstet. Gynecol. Scand., 2001, 80, 794.

[24] Averette H.E., Method M.W., Sevin B.U., Penalver M.A.: "Radical abdominal hysterectomy in the primary management of invasive cervical cancer". In: Rubin S.C., Hoskins W.J. (eds.). Cervical Cancer and Preinvasive Neoplasia. Philadelphia: LippincottRaven, 1996, 189.

[25] Landoni F., Maneo A., Colombo A., Placa F., Milani R., Perego P. et al.: "Randomised study of radical surgery versus radiotherapy for Stage lb-Ila cervical cancer". Lancet, 1997, 350, 535.

[26 I Morice P., Castaigne D., Pautier P., Rey A., Haie-Meder C., Leblanc M., Duvillard P.: "Interest of pelvic and paraaortic lymphadenectomy in patients with Stage TB and II cervical carcinoma". Gynecol. Oneal., 1999, 73, 106.

[27] Kim S.M., Choi H.S., Byun J.S.: "Overall 5-year survival rate and prognostic factors in patients with Stage 1B and IIA cervical cancer treated by radical hysterectomy and pelvic lymph node dissection". Int. J. Gynecol. Cancer, 2000, 10, 305.

[28] Odunsi K.O., Lele S., Ghamande S., Seago P., Driscoll D.L.: "The impact of pre-therapy extraperitoneal surgical staging on the evaluation and treatment of patients with locally advanced cervical cancer". Eur. J. Gynaecol. Oneal., 2001, 22, 325.

[29] Cosin J.A.,F owler J.M.,C hen M.D.,P aley P.J.,C arson L.F.,Tw iggs L.B.: "Pretreatment surgical staging of patients with cervical carcinoma: the case for lymph node debulking". Cancer, 1998, 82, 2241.

[30] Kim P.Y., Monk B.J., Chabra S., Burger R.A., Vasilev S.A., Manetta A. et al.: "Cervical cancer with paraaortic metastases: s1gnificance of residual paraaortic disease after surgical staging". Gynecol. Oneal., 1998, 69, 243.

[31] Potish R.A.,D owney G.O.,A dcock L.L.,P rem K.A.,T wiggs L.B.:'The role of surgical debulking in cancer of the uterine cervix" Int. J. Radiat. Oneal. Biol. Phys., 1989, 17, 979.

[32] Hacker N.F., Wain G.V., Nicklin J.L.: "Resection of bulky positive lymph nodes in patients with cervical carcinoma". Eur. J. Surg Oneal., 1991, 17,492.

[33] Berek J.S.: "Epithelial ovarian cancer". In: J.S. Berek and N.F. Hacker (eds.). Practical Gynecologic Oncology (2"' ed.). Baltimore, Williams and Wilkins, 1994, 327.

[34 I Burghardt E., Girardi F., Lahousen M., Tamussino K., Stettner H.: "Patterns of pelvic and paraaortic lymph node involvement in ovarian cancer". Gynecol. Oneal., 1991, 40, 103.

[35] Young R.C., Decker D.G., Wharton J.T., Piver M.S., Sindelar W.F., Edwards B.K., Smith J.P.: "Staging laparotomy in early ovarian cancer". JAMA, 1983, 250, 3072.

[36] Petru E., Lahousen M., Tamussino K., Pickel H., Stranzl H., Stettner H., Winter R.: "Lymphadenectomy in stage I ovarian cancer" Am. J. Ohstet. Gynecol., 1994, 170, 656.

[37] Wu P.C., Qu J.Y., Lang J.H., Huang R.L., Tang M.Y., Lian L.J.: "Lymph node metastasis of ovarian cancer: a preliminary survey of 74 cases of lymphadenectomy". Am. J. Ob stet. Gynecol., 1986, 155, 1103.

[38] Stratton J.F., Tidy J.A., Paterson M.E.:'The surgical management of ovarian cancer". Cancer Treat. Rev., 2001, 27, 111.

[39] Allen D.G., Coulter J.: "Survival of patients with epithelial ovarian cancer and the effect of lymphadenectomy in those with stage 3 disease". Aust. N. Z. J. Obstet. Gynaecol.,1 999,39, 420.

[40] Di Re F., Fontanelli R., Raspagliesi F., Di Re E.: "Pelvic and para-aortic lymphadenectomy in cancer of the ovary". Baillreres Clin. Obstet. Gynaecol., 1989, 131.

[41] Burghardt E., Pickel H., Lahousen M., Stettner H.: "Pelvic lymphadenectomy in operative treatment of ovarian cancer". Am. J Ohstet. Gynecol., 1986,155, 315.

[42] Scarabelli C., Gallo A., Zarrelli A., Visentin C., Campagnutta E.: "Systematic pelvic and para-aortic lymphadenectomy dunng cytoreductive surgery in advanced ovarian cancer: potential benefit on survival". Gynecol. Oneal., 1995, 56, 328.

[43] Liu P.C., Benjamin I., Morgan M.A., King S.A., Mikuta J.J., Rubin S.C.: "Effect of surgical debulking on survival in Stage IV ovarian cancer". Gyneco/. Oneal., 1997, 64, 4.

[44] Kigawa J., Minagawa Y., Itamochi H., Kanamori Y., Ishihara H., Terakawa N.: "Retroperitoneal lymphadenectomy, including the para-aortic nodes in patients with Stage Ill ovarian cancer". Am. J. Clin. Oncol., 1994, 17, 230

[45] Onda T.,Y oshikawa H.,Y asugi T.,M. Nishima M.,N akagawa S.,Y amada M. et al.: "Patients with ovarian carcinoma upstaged to stag III after systematic lymphadenctomy have similar survival to Stage I/II patients and superior survival to other Stage III patients" Cancer, 1998, 83, 1555.

[46] Parazzini F., Valsecchi G., Bolis G., Guarnerio P., Reina S., Polverino G., Silvestri D.: "Pelvic and paraortic lymph nodal status in advanced ovarian cancer and survival". Gynecol. Oneal., 1999, 74, 7.

[47] Hacker N.F.: "Vulvar cancer". In: Berek J.S., Hacker N.F. (eds.). Practical Gynecologic Oncology (3''ed.). Philadelphia: Williams & Wilkins, 2000, 553.

[48] Chu J., Tamimi H.K.,Figge D.C.: "Femoral node metastases with negative superficial inguinal nodes in early vulvar cancer". Am. J. Ohstet. Gynecol., 1981, 140, 337.

[49] Homesley H.D., Bundy B.N., Sedlis A., Yordan E., Berek J.S., Jahshan A., Mortel R.: "Assessment of current International F ederation of Gynecology and Obstetrics staging of vu Ivar carcinoma relative to prognostic factors for survival (a Gynecologic Oncology Group study)". Am. J. Obstet. Gynecol., 1991, 164, 997.

[50] Hacker N.F., Berek J.S., Lagasse L.D., Leuchter R.S., Moore J.G.: "Management of regional lymph nodes and their prognostic influence in vu Ivar cancer". Obstet. Gynecol., 1983, 61, 408.

[51] Monaghan J.M., Hammond I.G.: "Pelvic node dissection in the treatment of vulval carcinoma-is it necessary?". Br. J. Obstet. Gynaecol., 1984, 9, 270.

[52] Magrina J.F., Webb M.J., Gaffey T.A., Symmonds R.E.: "Stage I squamous cell cancer of the vulva". Am. J. Obstet. Gynecol., 1979, 134, 453.

[53] Stehman F.B., Bundy B.N., Dvoretsky P.M., Creasman W.T.: Early stage I carcinoma of the vulva treated with ipsilateral superficial inguinal lymphadenectomy and modified radical hemivulvectomy: a prospective study of the Gynecologic Oncology Group" Obstet. Gynecol., 1992, 79, 490.

[54] Parker R.T., Duncan I., Rampone J., Creasman W.: "Operative management of early invasive, epidermoid carcinoma of the vulva" Am. J. Obstet. Gynecol., 1975, 123, 349.

[55] Hacker N.F.,N ieberg R.K.,B erek J.S.,L euchter R.S.,L ucas W.E.,Tamimi H.K. et al.: "Superficially invasive vulvar cancer with nodal metastases". Gynecol. Oneal., 1983, 15, 65.

[56] Homesley H.D., Bundy B.N., Sedlis A., Adcock L.: "Radiation therapy versus pelvic node resection for carcinoma of the vulva with positive groin nodes". Ohstet. Gynecol., 1986, 68, 733.

[57] Morgan M.A., Mikuta J.J.: "Surgical management of vulvar cancer". Semin. Surg. Oneal., 1999, 17, 168.

[58] Levenback C.,C oleman R.L.,B urke T.W.,B odurka-Bevers D.,W olf J.K.,G ershenson D.M.: "Intraoperative lymphatic mapping and sentinel node identification with blue dye in patients with vulvar cancer". Gynecol. Oneal., 2001, 83, 276.