Casarin Jvan, Schivardi Gabriella, Artuso Valeria, Giudici Anna, Meschini Tommaso, De Vitis Luigi, Granato Vincenzo, Lembo Antonio, Cromi Antonella, Mariani Andrea, Bogani Giorgio, Multinu Francesco, Ghezzi Fabio
Department of Obstetrics and Gynecology, University of Insubria Faculty of Medicine and Surgery, Varese, Italy.
Department of Gynecology, European Institute of Oncology, Milan, Italy.
Int J Gynecol Cancer. 2025 Aug;35(8):101857. doi: 10.1136/ijgc-2024-005670. Epub 2025 Apr 19.
To evaluate the lymphatic-specific morbidity (specifically, lower extremity lymphedema) associated with laparoscopic management of early-stage endometrial cancer using the sentinel lymph node (SLN) algorithm by type of actual nodal assessment.
An ambispective study was conducted on consecutive patients surgically treated for apparent early-stage endometrial cancer who underwent laparoscopic staging according to the National Comprehensive Cancer Network SLN algorithm at a single institution from January 2020 to August 2023. Data on patient characteristics, surgical details, and post-operative complications were collected. Lymphedema screening was performed using a validated questionnaire.
A total of 239 patients were analyzed, with a questionnaire response rate of 85.4%. The study population was grouped based on actual surgical staging: hysterectomy+SLN (54.8%), hysterectomy+systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). The prevalence of lymphedema was significantly lower in the hysterectomy+SLN group compared with the hysterectomy+systematic pelvic lymphadenectomy group (21.4% vs 44.6%, p=0.003). Multivariable analysis showed a threefold increase in the risk of lymphedema for the hysterectomy+systematic pelvic lymphadenectomy group compared with the hysterectomy+SLN group: OR 3.11 (95% CI 1.47 to 6.58). No significant associations were found between lymphedema and other patient or tumor characteristics.
In the setting of a laparoscopic approach for early-stage endometrial cancer surgery, SLN mapping is associated with a significant reduction in lymphatic complications compared with a systematic lymph node dissection. Our findings provide additional evidence endorsing the adoption of SLN mapping during minimally invasive surgery for endometrial cancer. This technique ensures comparable diagnostic accuracy and also minimizes complications.
根据实际淋巴结评估类型，评估采用前哨淋巴结（SLN）算法对早期子宫内膜癌进行腹腔镜治疗相关的淋巴系统特异性发病率（具体为下肢淋巴水肿）。
对2020年1月至2023年8月在单一机构根据美国国立综合癌症网络SLN算法接受腹腔镜分期手术治疗的明显早期子宫内膜癌患者进行前瞻性研究。收集患者特征、手术细节和术后并发症的数据。使用经过验证的问卷进行淋巴水肿筛查。
共分析了239例患者，问卷回复率为85.4%。研究人群根据实际手术分期分组：子宫切除术+SLN（54.8%）、子宫切除术+系统性盆腔淋巴结清扫术（27.2%）和单纯子宫切除术（18%）。子宫切除术+SLN组的淋巴水肿患病率明显低于子宫切除术+系统性盆腔淋巴结清扫术组（21.4%对44.6%，p=0.003）。多变量分析显示，与子宫切除术+SLN组相比，子宫切除术+系统性盆腔淋巴结清扫术组发生淋巴水肿的风险增加了两倍：比值比3.11（95%置信区间1.47至6.58）。未发现淋巴水肿与其他患者或肿瘤特征之间存在显著关联。
在早期子宫内膜癌手术的腹腔镜治疗中，与系统性淋巴结清扫相比，SLN定位与淋巴系统并发症的显著减少相关。我们的研究结果为在子宫内膜癌微创手术中采用SLN定位提供了更多证据支持。该技术确保了相当的诊断准确性，同时也最大限度地减少了并发症。
