Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, USA; University of Central Florida College of Medicine, USA.
Florida Hospital Gynecologic Oncology, Florida Hospital Cancer Institute and the Global Robotics Institute, USA; University of Central Florida College of Medicine, USA; Florida State University College of Medicine, Orlando, FL 32804, USA.
Best Pract Res Clin Obstet Gynaecol. 2017 Nov;45:83-93. doi: 10.1016/j.bpobgyn.2017.04.006. Epub 2017 Apr 24.
Robotic-assisted laparoscopic surgery is the most common approach for the treatment of early-stage endometrial and cervical cancers in the US. Surgical staging requires pelvic and often aortic lymphadenectomy, depending on the primary tumor characteristics. Pelvic and aortic lymphadenectomy procedures may also be indicated for debulking of larger metastases to improve disease control. The infra-renal basin is an important anatomic site of metastasis from pelvic tumors, and robotic dissection techniques for this site have been described. In recent years, sentinel lymph node (SLN) mapping has been adopted into the National Comprehensive Cancer Network guidelines' surgical algorithm for uterine and cervical cancers. SLN mapping has higher sensitivity for the detection of nodal metastasis, despite removing fewer lymph nodes, and potentially reduces morbidities such as lower extremity lymphedema. This article reviews current robotic pelvic and para-aortic lymphadenectomy dissection techniques for endometrial and cervical cancers and discusses the recent integration of pelvic SLN mapping in the surgical algorithm.
机器人辅助腹腔镜手术是美国治疗早期子宫内膜癌和宫颈癌最常见的方法。手术分期需要进行盆腔淋巴结切除术，通常还需要进行腹主动脉旁淋巴结切除术，具体取决于原发性肿瘤的特征。对于较大的转移灶进行减瘤术以改善疾病控制时，也可能需要进行盆腔和腹主动脉旁淋巴结切除术。肾下窝是盆腔肿瘤转移的重要解剖部位，已经描述了针对该部位的机器人解剖技术。近年来，前哨淋巴结 (SLN) 绘图已被纳入国家综合癌症网络指南中子宫颈和宫颈癌的手术算法。尽管 SLN 绘图术切除的淋巴结较少，但对淋巴结转移的检测具有更高的敏感性，并可能减少下肢淋巴水肿等并发症。本文综述了当前用于子宫内膜癌和宫颈癌的机器人盆腔和腹主动脉旁淋巴结切除术的解剖技术，并讨论了最近在手术算法中纳入盆腔 SLN 绘图术的情况。
