IMR Press / CEOG / Volume 50 / Issue 9 / DOI: 10.31083/j.ceog5009181
Open Access Review
A Reappraisal of Lymphadenectomy in Common Gynecological Cancers
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1 Department of Obstetrics and Gynecology, Francois Quesnay Hospital, 78200 Mantes-la-Jolie, France
2 Department of Obstetrics & Gynecology, Moulins-Yzeure Hospital, 03000 Moulins, France
3 Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, 80123 Palermo, Italy
4 Department of Obstetrics and Gynecology, Hospital de la Santa Creu i Sant Pau, 08041 Barcelona, Catalonia, Spain
5 Department of Obstetrics and Gynecology, Dubai London Clinic and Specialty Hospital, 00000 Dubai, United Arab Emirates
6 Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy
7 Department of Obstetrics and Gynecology, Policlinico G Rodolico, University of Catania, 95131 Catania, Italy
*Correspondence: dr.nassirhabib@gmail.com (Nassir Habib)
Clin. Exp. Obstet. Gynecol. 2023, 50(9), 181; https://doi.org/10.31083/j.ceog5009181
Submitted: 29 May 2023 | Revised: 29 June 2023 | Accepted: 5 July 2023 | Published: 30 August 2023
(This article belongs to the Special Issue The Role of Lymphadenectomy in Gynecologic Oncology)
Copyright: © 2023 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.
Abstract

Objectives: Lymph node dissection (LND) in gynecological malignancies has always been a cornerstone in the diagnosis of metastasis, it is also considered an important prognostic factor, and a reliable guide to management strategies. However, its incidence of complications, namely lymphedema, vascular injuries and other lesions, has led to a reconsideration of its efficacy and a comparison of the role of systematic vs. sentinel lymph node (SLN) dissection. Mechanism: Review of the literature using keywords such as “lymph nodes”, “sentinel lymph nodes”, “morbidity and mortality”, “gynecological cancers”, “endometrial cancer”, “ovarian cancer”, and “cervical cancer”. Findings in Brief: In the case of endometrial cancer, several studies have investigated the efficacy of SLN compared with systematic LND. Most of the results demonstrated the efficacy of SLN dissection in endometrial cancer, with the added benefit of lower morbidity. In patients with ovarian cancer, the mainstay of treatment is debulking with optimal cytoreductive surgery. Recent studies have compared systematic lymphadenectomy to non-lymphadenectomy, with an additional advantage in the cases of lymphadenectomy. However, since its publication, the lymphadenectomy in ovarian cancers (LIONS) trial, has revolutionized the standard of care for patients with advanced ovarian cancer and has called into question the increased morbidity and mortality in systematic lymphadenectomy. In cervical cancers, lymph node status is considered to be the most important prognostic factor. In this case, limiting lymphadenectomy to the borders of the inferior mesenteric artery seems promising, and studies are currently being carried out to investigate the feasibility of SLN dissection instead of systematic lymph node dissection. Conclusions: SLN dissection is associated with lower morbidity and mortality, and has been shown to be superior to systematic lymphadenectomy in several studies. However, more research and specific guidelines are needed to better select either one or the other method in the management of gynecological cancers.

Keywords
lymph nodes
sentinel lymph nodes
morbidity and mortality
gynecological cancers
endometrial cancer
ovarian cancer
cervical cancer
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