The diagnostic role of lymph node dissection in early-stage
endometrial cancer
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LND should be used to guide adjuvant
treatment(15) by stratifying patients by risk and
not staging alone(16).
LND shows varied use in guiding adjuvant treatment because
pathological prognostic features differ between different risk
stratification systems(12,17).
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The prognostic role of lymph node dissection in early-stage
endometrial cancer
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Low risk group:
LND is not warranted in EC staging based on the ESMO-ESGO-ESTRO 2016
as there is a very low risk of LN metastasis(18,19).
LND may be warranted in EC staging to detect occult LN
metastasis(20).
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Intermediate and high-intermediate risk groups:
LND is not warranted in EC staging as patients present with a low
proportion of positive LNs(21) with unclear
guidelines for adjuvant therapy(5).
LND may be warranted in EC staging when adjuvant therapy is
recommended(5).
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High risk group:
LND is warranted in EC staging based on the ESMO-ESGO-ESTRO 2016 due
to high prevalence of lymph node involvement(22).
Without LND, treatment would rely solely on radiation and
chemotherapy(23).
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The therapeutic role of lymph node dissection in early-stage
endometrial cancer
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Low risk group:
There is no therapeutic benefit to LND based on the ESMO-ESGO-ESTRO
2016(20), although the evidence supporting these
guidelines misclassify low risk patients(15,24).
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Intermediate – high risk groups:
While LND demonstrated improved survival in a large patient
cohort(25,26), there is no therapeutic benefit to
LND(15,24).
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Role of lymph node dissection in advanced endometrial
cancer
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LND is beneficial in advanced EC based on ESMO-ESGO-ESTRO 2016.
LND is effective at diagnosing advanced EC and tailoring adjuvant
therapy(27).
Patients benefited from undergoing LND, before debulking
therapy(28).
LND is used to calculate LN ratio, the strongest independent
prognostic parameter in stage IIIC EC(29).
LND is not beneficial in advanced EC.
LND may be omitted for non-bulky advanced EC patients receiving
appropriate adjuvant therapy(30).
There is no consensus regarding the treatment of stage IVB
EC(31).
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What defines adequate lymph node dissection?
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Lymph Node Counts:
Improved survival is correlated with >10 LNs being
removed by LND based on ESMO-ESGO-ESTRO
2016(5,24,27).
Alternatively, improved survival is thought to correlate with
>20 LNs being removed by LND(32).
Lymph Node Targets:
There is a need for pelvic and para-aortic LND(33)
up to the renal vessels(34) based on ESMO-ESGO-ESTRO
2016.
Special attention is needed for isolated positive para-aortic
LNs(35).
Surgical Method:
Minimally invasive surgery (MIS) is preferred over laparotomy based on
ESMO-ESGO-ESTRO 2016(5,36–38) while laparotomy is
preferred for complex cases(39).
Within MIS, robotic and laparoscopic LND shows similar
adequacy(38–40) while robotic has certain
advantages over laparoscopic surgery(38,41,42).
Role of sentinel lymph node (SLN) dissection:
ESMO-ESGO-ESTRO recognises SLN algorithms as a potential alternative
to systematic LND in early stage EC(5,43) supported
by recent studies(23,36,44).
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