Intermediate and high-intermediate risk groups
LND is vital to bridge the gap between pathological prognostic features
such as lymphovascular space invasion (LVSI) and adjuvant therapy.
ESMO-ESGO-ESTRO 2016 outlines adjuvant therapy recommendations in
considerable detail for the latter two sub-groups of intermediate risk
patients. LND could therefore be considered justified in this case.
However, in the first sub-group (LVSI-positive, G1/2 and superficial
myometrial invasion (<50%)), even if LND is commenced,
guidelines for adjuvant therapy are not clear (Table 3).
A matched-pair retrospective study highlighted that a low proportion of
intermediate-risk patients who underwent LND had positive LNs compared
to unstaged patients(30). Furthermore, across all risk
groups, surgery-related adverse effects of LND must not be
ignored(29). Specifically in the intermediate risk
group, postoperative complications such as lymphocyst formation and
lower-limb lymphoedema were significantly higher in the LND
group(30–32). Interestingly however, infection rates
were higher in unstaged patients, perhaps because non-surgical
infections were also included(30).
Ultimately, there is conflicting evidence comparing the benefit of
knowing the LN status to the adverse effects of LND.