Perzyło Katarzyna, Miotła Paweł, Lis Ernest, Rechberger Tomasz
Ii Katedra i Klinika Ginekologii, Uniwersytet Medyczny w Lublinie, Polska.
Ginekol Pol. 2013 Jul;84(7):630-6. doi: 10.17772/gp/1616.
Lymphadenectomy is an integral part of gynecological cancer surgery however there is still lack of standardization in the terminology used. In the current literature several types of surgical procedures for pelvic lymph nodes dissection are recognized. Complete pelvic lymphadenectomy is defined as the removal of all fatty lymphatic tissue from the predicted areas of high incidence of lymph nodes with possible metastatic involvement. Para-aortic lymphadenectomy is defined as the removal of all lymphatic tissue from the aortic region. The latter is divided into two levels: the lower--up to the inferior mesenteric artery and the upper--up to the left renal vein. Another classification divided pelvic and aortic lymphadenectomy into three classes. Class I is defined as the removal of the chosen lymph nodes, class II as the removal of lymph nodes located ventrally and laterally to the large retroperitoneal pelvic vessels, obturator nerves and laterally to the aorta and the inferior vena cava, whereas class III as the complete removal of lymphatic tissue surrounding the iliac vessels, obturator pits, dorsally to the obturator nerve and the presacral lymph tissue around the aorta and the inferior vena cava. In each gynecological cancer depending on the severity of the disease different procedures are applied concerning lymphadenectomy. In patients with advanced ovarian cancer systematic lymphadenectomy prolongs the survival rate. Omission of systematic lymphadenectomy can be considered only for patients with mucinous carcinoma G1 level. In the case of vulvar cancer removal of pelvic, iliac and obturator lymph nodes is inappropriate as it has not been proven to result in an increased survival rate. Inguinal lymphadenectomy in this cancer depends on the stage and location of the primary tumor--at an early stage vulvar cancer located laterally a superficial, unilateral inguinal lymphadenectomy can be performed, if the primary lesion is located centrally an inguinal lymphadenectomy should be performed on both sides. Deep inguinal lymphadenectomy should be performed only in cases where: primary tumor is located centrally in case of cancer in the early stages, in advanced stage and in patients with metastases in the superficial nodes. Sentinel lymph node biopsy is an alternative method that can be offered to patients with early-stage vulvar cancer located laterally. Lymphadenectomy in endometrial cancer is beneficial in stages I G3, II and III. In stages I G1 and G2 an increase in the survival time has not been shown. The cervical cancer stage IB-IIA removal of para-aortic lymph nodes (to the mesenteric artery) is indicated in patients with large tumors and suspected or known disease in the pelvic nodes. In patients in whom diagnostic imaging studies have not shown metastasis in para-aortic and pelvic lymph nodes or distant metastasis, para-aortic lymphadenectomy can be omitted. Further randomized studies are needed to elucidate the necessity and extent of lymphadenectomy in given gynecological cancers.
淋巴结切除术是妇科癌症手术的一个重要组成部分，然而在所用术语方面仍缺乏标准化。在当前文献中，公认有几种盆腔淋巴结清扫的手术方式。完全盆腔淋巴结切除术定义为从淋巴结转移可能累及的高发病区域切除所有脂肪淋巴组织。腹主动脉旁淋巴结切除术定义为从主动脉区域切除所有淋巴组织。后者分为两个水平：低位——至肠系膜下动脉，高位——至左肾静脉。另一种分类将盆腔和腹主动脉旁淋巴结切除术分为三类。I类定义为切除选定的淋巴结，II类定义为切除位于盆腔大腹膜后血管腹侧和外侧、闭孔神经以及主动脉和下腔静脉外侧的淋巴结，而III类定义为完全切除髂血管周围、闭孔窝、闭孔神经背侧以及主动脉和下腔静脉周围的骶前淋巴组织。在每种妇科癌症中，根据疾病的严重程度，关于淋巴结切除术应用不同的手术方式。在晚期卵巢癌患者中，系统性淋巴结切除术可延长生存率。仅对于黏液性G1级癌患者可考虑省略系统性淋巴结切除术。在外阴癌病例中，切除盆腔、髂和闭孔淋巴结是不合适的，因为尚未证明其能提高生存率。该癌症的腹股沟淋巴结切除术取决于原发肿瘤的分期和位置——在外阴癌早期且位于外侧时，可进行浅表、单侧腹股沟淋巴结切除术；如果原发病变位于中央，则应双侧进行腹股沟淋巴结切除术。仅在以下情况下应进行深部腹股沟淋巴结切除术：早期癌症且原发肿瘤位于中央、晚期癌症以及浅表淋巴结有转移的患者。前哨淋巴结活检是一种可提供给外侧型早期外阴癌患者的替代方法。子宫内膜癌的淋巴结切除术在I期G3、II期和III期有益。在I期G1和G2期，未显示生存时间增加。宫颈癌IB-IIA期，对于肿瘤较大且盆腔淋巴结可疑或已知有病变的患者，建议切除腹主动脉旁淋巴结（至肠系膜动脉）。对于诊断性影像学检查未显示腹主动脉旁和盆腔淋巴结转移或远处转移的患者，可省略腹主动脉旁淋巴结切除术。需要进一步的随机研究来阐明特定妇科癌症中淋巴结切除术的必要性和范围。
