Gynaecology Oncology Department, Liverpool Hospital, Sydney, NSW, Australia.
Westmead Hospital, Sydney, NSW, Australia.
J Robot Surg. 2022 Oct;16(5):1111-1115. doi: 10.1007/s11701-021-01321-5. Epub 2021 Dec 2.
Lymph node (LN) evaluation in endometrial cancer is controversial. Sentinel lymph node biopsy (SLNB) allows for an accurate nodal assessment while minimising the risks of a full pelvic lymph node dissection (PLND). The aims of this study are to examine the characteristics and peri-operative outcomes of women with atypical hyperplasia (AH) or endometrial cancer undergoing robotic-assisted hysterectomy (RAH) ± SLNB or PLND; to examine the utilisation, feasibility and role of SLNB and compare their peri-operative outcomes. Retrospective cohort study from December 2018 to February 2021 of women who underwent RAH ± LN assessment for endometrial cancer or AH. 115 women underwent RAH. 59% had SLNB, 29% had no LN assessment, and 12% had PLND. The final diagnosis was mostly early stage low-grade disease; Stage 1A-50%, Grade 1 endometrioid adenocarcinoma (EAC)-56%. The detection rate was 90%. There was a statistically significant trend towards performing SLNB over time (P value 0.004). There was a statistically shorter length of stay, less estimated blood loss, and shorter surgical duration in the SLNB cohort, compared to the no LN assessment cohort (P values 0.02, 0.01, and 0.03, respectively). There was statistically significant less estimated blood loss and surgical duration in the SLNB compared to the PLND cohort (P values 0.03 and 0.001, respectively). SLNB at RAH was utilised and feasible. It was safe with a low complication rate and had advantages compared to PLND cohort. SLNB should be considered in suitable selected women undergoing surgery for endometrial cancer or AH.
淋巴结（LN）评估在子宫内膜癌中存在争议。前哨淋巴结活检（SLNB）可在最大限度降低全盆腔淋巴结清扫术（PLND）风险的同时，对淋巴结进行准确评估。本研究旨在检查接受机器人辅助子宫切除术（RAH）±SLNB 或 PLND 的具有非典型增生（AH）或子宫内膜癌的女性的特征和围手术期结局；检查 SLNB 的应用、可行性及其作用，并比较其围手术期结局。这是一项回顾性队列研究，纳入 2018 年 12 月至 2021 年 2 月期间因子宫内膜癌或 AH 接受 RAH±LN 评估的女性。共 115 名女性接受了 RAH 手术。59%的患者进行了 SLNB，29%的患者未进行 LN 评估，12%的患者进行了 PLND。最终诊断主要为早期低级别疾病；IA 期 50%，1 级子宫内膜样腺癌（EAC）56%。检测率为 90%。随着时间的推移，SLNB 的应用呈明显上升趋势（P 值 0.004）。与未行 LN 评估的患者相比，行 SLNB 的患者在住院时间、估计失血量和手术时间方面均较短（P 值分别为 0.02、0.01 和 0.03）。与 PLND 组相比，SLNB 组的估计失血量和手术时间较短（P 值分别为 0.03 和 0.001）。在 RAH 中进行 SLNB 是可行的。其并发症发生率低，安全性高，与 PLND 组相比具有优势。对于因子宫内膜癌或 AH 而接受手术的合适选择女性，应考虑进行 SLNB。
