Department of Gynecology, University of Leipzig, Leipzig, Germany.
Gynecol Oncol. 2012 Apr;125(1):168-74. doi: 10.1016/j.ygyno.2011.12.419. Epub 2011 Dec 8.
In cervical cancer lymph node dissection is applied for regional tumor staging. Up to now, the use of (chemo)radiation in the nodal positive patient has prevented the exact pattern analysis of regional tumor spread and the evaluation of the therapeutic role of lymph node dissection. New surgical techniques founded on ontogenetic instead of functional anatomy for the treatment of cervical cancer dispensing with adjuvant radiotherapy offer the possibility to accurately determine the topography of regional lymph node metastases which is the prerequisite for optimized diagnostic and therapeutic lymph node dissection.
Patients with cervical cancer FIGO stages IB-IIB were treated with total mesometrial resection (TMMR) and lymph node dissection after exposing the ontogenetic visceroparietal compartments of the female pelvis. Resected lymph nodes were allocated to regions topographically defined by the embryonic development of the iliac, lumbar and mesenteric lymph systems prior to histopathological assessment.
71 of 305 treated patients had lymph node metastases. Topographic distribution of these metastases at primary surgery and analysis of pelvic failures showed a spatial pattern related to the ontogenesis of the abdominopelvic lymphatic system. Five-year locoregional tumor control probability was 96% (95% CI: 94-98) for the whole group and 87% (95% CI: 77-97) for nodal positive patients.
The pattern of regional spread in cervical cancer can be comprehended and predicted from ontogenetic lymphatic compartments. In patients with early cervical cancer lymph node dissection based on ontogenetic anatomy achieves high regional tumor control without adjuvant radiation.
在宫颈癌淋巴结清扫中，用于区域肿瘤分期。到目前为止，淋巴结阳性患者使用（化疗）放疗已经阻止了对区域肿瘤扩散的确切模式分析，以及对淋巴结清扫治疗作用的评估。基于胚胎发生而不是功能解剖学的新手术技术为宫颈癌的治疗提供了可能，无需辅助放疗，从而能够准确确定区域淋巴结转移的局部解剖位置，这是优化诊断和治疗性淋巴结清扫的前提。
采用经阴道全子宫系膜切除术（TMMR）和淋巴结清扫术治疗 FIGO 分期为 IB-IIB 的宫颈癌患者，在暴露女性骨盆的胚胎发生内脏壁层间隙后进行。切除的淋巴结按照胚胎发育过程中髂、腰和肠系膜淋巴系统的位置分配到特定区域，然后进行组织病理学评估。
305 例治疗患者中有 71 例发生淋巴结转移。原发手术时的转移部位分布以及盆腔失败的分析显示，与腹盆腔淋巴结系统的胚胎发生相关的空间模式。全组 5 年局部区域肿瘤控制率为 96%（95%CI：94-98），淋巴结阳性患者为 87%（95%CI：77-97）。
宫颈癌的区域扩散模式可以从胚胎发生的淋巴间隙中理解和预测。在早期宫颈癌患者中，基于胚胎发生解剖学的淋巴结清扫可实现高区域肿瘤控制，无需辅助放疗。
