Obermair Helena M, O'Hara Montana, Obermair Andreas, Janda Monika
Department of Obstetrics and Gynaecology, Royal North Shore Hospital, Sydney, New South Wales, Australia.
Centre of Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
Gynecol Oncol Rep. 2021 Apr 1;36:100763. doi: 10.1016/j.gore.2021.100763. eCollection 2021 May.
Sentinel lymph node dissection (SLND) is presently used by the majority of gynaecologic oncologists for surgical staging of endometrial cancer. SLND assimilated into routine surgical practice because it increases precision of surgical staging and may reduce morbidity compared to a full, systematic LND. Previous research focussed on the accuracy of SLND. Patient centred outcomes have never been conclusively demonstrated. The objective of this systematic review was to evaluate patient centred outcomes of SLND for endometrial cancer patients. Literature published in the last five years (January 2015 to April 2020) was retrieved from PubMed, EMBASE, and Cochrane library, across five domains: (1) perioperative outcomes; (2) adjuvant treatment; (3) patient-reported outcomes (PROs); (4) lymphedema, and (5) cost. Covidence software ascertained a standardised and monitored review process. We identified 21 eligible studies. Included studies were highly heterogeneous, with widely varying outcome measures and reporting. SLND was associated with shorter operating times and lower estimated blood loss compared to systematic LND, but intra-operative and post-operative complications were not conclusively different. There was either no impact, or a trend towards less adjuvant treatment used in patients with SLND compared to systematic LND. SLND had lower prevalence rates of lymphedema compared to systematic LND, although this was shown only in three retrospective studies. Costs of surgical staging were lowest for no node sampling, followed by SLND, then LND. PROs were unable to be compared because of a lack of studies. The quality of evidence on patient-centred outcomes associated with SLND for surgical staging of endometrial cancer is poor, particularly in PROs, lymphedema and cost. The available studies were vulnerable to bias and confounding. PROSPERO (CRD42020180339).
目前，大多数妇科肿瘤学家在子宫内膜癌的手术分期中采用前哨淋巴结清扫术（SLND）。SLND已融入常规手术操作，因为与全面、系统性的淋巴结清扫术（LND）相比，它提高了手术分期的精确性，且可能降低发病率。以往的研究集中在前哨淋巴结清扫术的准确性上。以患者为中心的结局从未得到确凿证实。本系统评价的目的是评估子宫内膜癌患者接受前哨淋巴结清扫术的以患者为中心的结局。从PubMed、EMBASE和Cochrane图书馆检索过去五年（2015年1月至2020年4月）发表的文献，涉及五个领域：（1）围手术期结局；（2）辅助治疗；（3）患者报告结局（PROs）；（4）淋巴水肿；（5）费用。Covidence软件确定了标准化且可监测的评价过程。我们确定了21项符合条件的研究。纳入的研究具有高度异质性，结局测量和报告差异很大。与系统性淋巴结清扫术相比，前哨淋巴结清扫术的手术时间更短，估计失血量更低，但术中及术后并发症并无确凿差异。与系统性淋巴结清扫术相比，前哨淋巴结清扫术患者使用的辅助治疗要么没有影响，要么有减少的趋势。与系统性淋巴结清扫术相比，前哨淋巴结清扫术的淋巴水肿患病率更低，不过这仅在三项回顾性研究中得到体现。手术分期的费用，无淋巴结采样最低，其次是前哨淋巴结清扫术，然后是淋巴结清扫术。由于缺乏研究，无法对患者报告结局进行比较。与前哨淋巴结清扫术用于子宫内膜癌手术分期相关的以患者为中心的结局的证据质量较差，尤其是在患者报告结局、淋巴水肿和费用方面。现有研究容易出现偏倚和混杂。国际前瞻性系统评价注册库（CRD42020180339）。
