Pinelli Ciro, Artuso Valeria, Bogani Giorgio, Laganà Antonio Simone, Ghezzi Fabio, Casarin Jvan
Obstetrics and Gynecology Department, the University of Insubria, Varese, Italy.
Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy.
Transl Cancer Res. 2020 Dec;9(12):7778-7784. doi: 10.21037/tcr-20-2165.
Endometrial cancer (EC) is the most common gynecological malignancy in developed countries, and surgery represents the pivotal part of treatment. Hysterectomy and salpingo-oophorectomy allow removing the primary tumor and defining patients at higher risk, who might benefit from adjuvant therapies. Minimally invasive surgery is associated with superior postoperative outcomes and represents a safe and effective approach for surgical staging of EC. The lymph node status evaluation in EC is still a matter of debate. Over the last twenty years much has changed, moving from a full systematic pelvic and paraaortic lymphadenectomy for staging purpose to the removal of the pelvic (with or without paraaortic) lymph nodes only in selected EC classes of risk. Two randomized trials failed to demonstrate survival benefits of lymphadenectomy in case of apparent early stage EC; however, its prognostic role has never been questioned. At present, with the aim of reducing the surgical-related morbidity, sentinel node mapping is emerging as a safe and valid alternative to lymphadenectomy for EC staging, demonstrating high accuracy and an increased detection of lymph nodes metastasis. Here, we performed a review of the most significant studies, which supported the changes in the lymph node status evaluation for EC over the last two decades.
子宫内膜癌（EC）是发达国家最常见的妇科恶性肿瘤，手术是治疗的关键部分。子宫切除术和输卵管卵巢切除术能够切除原发肿瘤，并确定可能从辅助治疗中获益的高危患者。微创手术具有更好的术后效果，是子宫内膜癌手术分期的一种安全有效的方法。子宫内膜癌的淋巴结状态评估仍是一个有争议的问题。在过去二十年里，情况发生了很大变化，从为了分期目的进行的全系统盆腔和腹主动脉旁淋巴结清扫，转变为仅在选定的子宫内膜癌风险类别中切除盆腔（有或没有腹主动脉旁）淋巴结。两项随机试验未能证明在明显早期子宫内膜癌病例中淋巴结清扫对生存有益；然而，其预后作用从未受到质疑。目前，为了降低手术相关的发病率，前哨淋巴结 mapping 正在成为一种安全有效的替代方法，用于子宫内膜癌分期的淋巴结清扫，显示出高准确性和增加的淋巴结转移检测率。在此，我们对最重要的研究进行了综述，这些研究支持了过去二十年来子宫内膜癌淋巴结状态评估的变化。
