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Jornadas SoGOCyL 2018

Se celebrará la V Reunión de la Sociedad de Ginecología Oncológica y Patología Mamaria de Castilla y León los días 3, 4 y 5 de Mayo de 2018

Jornadas SoGOCyL 2016

Se celebrará la IV Reunión de la Sociedad de Ginecología Oncológica y Patología Mamaria de Castilla y León los días 5, 6 y 7 de Mayo de 2016

I JORNADA DE CIRUGIA ONCOLOGICA PERITONEAL

Se celebra el 25 de Noviembre de 2014 a las 10:00 horas en el Salón de Actos del Hospital Universitario Río Hortega de Valladolid...

Reunión de presentación de la UNIDAD DE REFERENCIA REGIONAL DE CIRUGIA ONCOLOGICA PERITONEAL

Se celebra el 3 de Noviembre de 2014, 17:00 horas en Salón de Actos de la Gerencia Regional de Salud...

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Para-aortic lymphadenectomy in endometrial cancer

Escrito por SoGOCyL Sábado, 01 de Enero de 2011 11:26

Para-aortic lymphadenectomy in endometrial cancer

Lancet, Volume 376, Issue 9740, Pages 511 - 512, 14 August 2010 <Previous Article|Next Article>doi:10.1016/S0140-6736(10)61245-7Cite or Link Using DOI

Clare Griffin a, Ann Marie Swart a, Wendi Qian a, Henry Kitchener b

We were not surprised that the results of the retrospective cohort analysis of SEPAL1 differed from those of two randomised controlled trials.2, 3 With a hazard ratio for overall survival of 1·16 (favouring no lymphadenectomy) in ASTEC,2 it is extremely unlikely that conclusions would change with long-term follow-up because there would have to be a large, late effect which is not suggested by SEPAL. Lymphadenectomy significantly increases moderate and severe morbidity, particularly lymphoedema, and removing more lymph nodes might not be better (figure).

ASTEC effect of lymphadenectomy in centres grouped according to median nodes removed

O-E=observed minus expected. Outer bars show 99% CI, inner bars show 95% CI.

Lack of information about methods makes the results impossible to interpret, particularly patient selection and surgery details (operation length, blood loss, postoperative hospital stay, and related deaths). The median age of 56 years suggests substantial selection (median age was 63 years in ASTEC). Data were gathered over 18 years and information about the distribution of patients in each group across time and any time effect on survival is important. Bias due to differences between the hospitals cannot be excluded, with differing adjuvant protocols and almost double the number of pelvic nodes removed in some hospitals compared with others.

In women at intermediate or high risk of recurrence, the substantial difference in adjuvant chemotherapy received (77% vs 45%) is important. Chemotherapy reduces distal metastases,4 potentially improving survival and the effect of para-aortic lymphadenectomy. The benefit in high-risk patients receiving chemotherapy is only just significant. Since type of lymphadenectomy and adjuvant treatment were independent risk factors for overall survival, there are strong statistical arguments for sensitivity analyses excluding those receiving adjuvant treatment.

Aortic lymphadenectomy was not assessed in either randomised trial and the results of this observational study do not invalidate the conclusions of these trials nor provide conclusive evidence of a real treatment effect.

Lymphadenectomy in endometrial cancer

Escrito por SoGOCyL Sábado, 01 de Enero de 2011 11:24

Lymphadenectomy in endometrial cancer

The Lancet, Volume 373, Issue 9670, Pages 1169 - 1170, 4 April 2009 <Previous Article|Next Article>doi:10.1016/S0140-6736(09)60676-0Cite or Link Using DOI

Frédéric Amant a, Patrick Neven a, Ignace Vergote a

The ASTEC study group1 conclude that a systematic lymphadenectomy in endometrial cancer cannot be recommended as a routine procedure because of lack of benefit in terms of recurrence-free and overall survival. However, there are several reasons why the ASTEC trial did not show improved overall survival with routine lymphadenectomy.

First, the number of lymph nodes resected was insufficient in many patients. Although the median number resected overall was 12, 35% of patients in the lymphadenectomy group had nine or fewer lymph nodes removed. Cragun and colleagues2 showed that removal of more than 11 pelvic nodes had an effect on overall survival. Chan and colleagues3 showed that, in intermediate-risk and high-risk endometrial cancer, patients with more than 10 nodes harvested have an improved outcome.

Second, many patients with low-risk endometrial carcinoma, and hence a low risk of lymph-node involvement, were included (eg, only 41% had stage IC—IIB disease, and only 22% presented with poorly differentiated tumours). The high rate of inclusion of low-risk patients and the low number of lymph nodes removed are the reasons for the low rate of involved lymph nodes seen in the lymphadenectomy group (9%).

Third, the study group did not assess the para-aortic nodes. However, up to 67% of patients with lymph-node metastases have involved para-aortic nodes.4 Fourth, the ASTEC trial was too small to detect an overall survival difference because the expected proportion of isolated pelvic lymph-node recurrences is as low as 2—3% in early endometrial carcinoma.

In conclusion, we believe that there is still an indication to do a comprehensive lymphadenectomy to select patients at high risk of pelvic side wall recurrence. The selection of patients for a lymphadenectomy should be based on myometrial invasion, grade, and diameter of the tumour.5

We declare that we have no conflict of interest.

 

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