Department of Gynecology and Obstetrics, University of Parma, Parma, Italy.
Department of Gynecologic Oncology, ARNAS Civico Hospital of Palermo, Palermo, Italy
Int J Gynecol Cancer. 2019 Feb;29(2):312-319. doi: 10.1136/ijgc-2018-000084. Epub 2019 Jan 18.
To determine the incidence of long term lymphadenectomy complications in primary surgery for endometrial cancer and to elucidate risk factors for these complications.
A retrospective chart review was carried out for all patients with endometrial cancer managed at Parma University Hospital Unit of Gynecology and Obstetrics between 2010 and 2016. Inclusion criteria were surgical procedure including hysterectomy and lymphadenectomy (pelvic or pelvic and aortic). We identified patients with postoperative lymphocele and lower extremity lymphedema. Logistic regression analysis was used to identify predictive factors for postoperative complications.
Of the 249 patients tested, 198 underwent pelvic lymphadenectomy (79.5%), and 51 (20.5%) of those underwent both pelvic and para-aortic lymphadenectomy. Among the 249 patients, 92 (36.9 %) developed lymphedema while 43 (17.3%) developed lymphocele. Multivariate analysis showed that addition of para-artic lymphadenectomy was an independent predictor for both lymphedema (odds ratio (OR) 2.764, 95% confidence interval (CI) 1.023 to 7.470) and lymphocele (OR 5.066, 95% CI 1.605 to 15.989). Moreover, postoperative adjuvant radiotherapy (OR 2.733, 95% CI 1.149 to 6.505) and identification of any positive lymph node (OR 19.391, 95% CI 1.486 to 253.0) were significantly correlated with lymphedema, while removal of circumflex iliac nodes (OR 8.596, 95% CI 1.144 to 65.591) was associated with lymphoceles occurrence.
Although sentinel lymph node navigation is a promising option, lymphadenectomy represents the primary treatment in many patients with endometrial cancer. However, comprehensive nodal dissection remains associated with a high rate of long term complications, such as lymphedema and lymphocele. Avoiding risk factors that are related to the development of these postoperative complications is often difficult and, therefore, the strategy to assess lymph nodal status in these women must be tailored to obtain the maximum results in terms of oncological and functional outcome.
确定子宫内膜癌初次手术中长期淋巴结清扫并发症的发生率，并阐明这些并发症的危险因素。
对 2010 年至 2016 年间在帕尔马大学医院妇科接受治疗的所有子宫内膜癌患者进行回顾性图表审查。纳入标准为包括子宫切除术和淋巴结清扫术（盆腔或盆腔加腹主动脉）在内的手术程序。我们确定了术后淋巴囊肿和下肢淋巴水肿的患者。使用逻辑回归分析确定术后并发症的预测因素。
在 249 名接受测试的患者中，198 名患者接受了盆腔淋巴结清扫术（79.5％），其中 51 名患者（20.5％）同时接受了盆腔和腹主动脉旁淋巴结清扫术。在 249 名患者中，92 名（36.9％）出现淋巴水肿，43 名（17.3％）出现淋巴囊肿。多变量分析显示，附加腹主动脉旁淋巴结清扫术是淋巴水肿（优势比（OR）2.764，95％置信区间（CI）1.023 至 7.470）和淋巴囊肿（OR 5.066，95％CI 1.605 至 15.989）的独立预测因素。此外，术后辅助放疗（OR 2.733，95％CI 1.149 至 6.505）和任何阳性淋巴结的检出（OR 19.391，95％CI 1.486 至 253.0）与淋巴水肿显著相关，而旋髂腹股沟淋巴结切除（OR 8.596，95％CI 1.144 至 65.591）与淋巴囊肿的发生相关。
虽然前哨淋巴结导航是一种很有前途的选择，但淋巴结清扫术仍是许多子宫内膜癌患者的主要治疗方法。然而，全面的淋巴结清扫术仍与长期并发症（如淋巴水肿和淋巴囊肿）的高发生率相关。避免与这些术后并发症发生相关的危险因素通常很困难，因此，必须针对这些女性的淋巴结状态评估制定策略，以在肿瘤学和功能结果方面获得最大效果。
