ABSTRACT
Objective
Although its use in endometrial cancer staging is relatively new, sentinel lymph node
(SLN) sampling has been shown to be highly accurate and is associated with few complications.
However, some studies report lower rates of detection with SLN sampling among patients
with obesity. The aim of the current study is to evaluate the feasibility of SLN sampling
in endometrial cancer for patients with obesity, and to determine whether omitting
lymph node dissection (LND) in surgical staging using SLN sampling impacts oncologic
outcomes.
Methods
we conducted a retrospective study of patients with obesity (BMI ≥35 kg/m2), diagnosed with endometrial carcinoma between 2007 and 2017, that compared surgical
and oncologic outcomes of 2 cohorts: patients who underwent LND and patients who underwent
SLN without lymphadenectomy. The primary outcome was operative time. Secondary outcomes
included intraoperative bleeding; lymph node assessment information; intraoperative
and postoperative adverse events; and oncologic outcomes including progression-free
survival (PFS), overall survival (OS), and disease-specific survival (DSS). PFS was
defined as the time from surgery to the recurrence or death from any cause. OS was
defined as time from diagnosis to death or the last date the patient was known to
be alive, and DSS was defined as the time from the surgery to death from the disease.
Results
Out of 223 patients with a median BMI of 40.6 kg/m2, 140 underwent LND and 83 underwent SLN alone. The median operative time for patients
in the SLN group was shorter than that of patients in the LND group (190.5 [range
108–393] vs. 238 [131–440] min; P < 0.001), and the SLN group had lower median estimated blood loss than the LND group
(30 [range 0–300] vs. 40 [range 0–800] mL; P = 0.03). At the 24-month follow-up cut-off, 98% of patients were alive and 95.5%
were disease free, with no significant differences in OS, DSS, and PFS between the
2 groups (P = 0.7, P = 0.8, and P = 0.4, respectively).
Conclusions
In patients with obesity, omitting LND from surgical staging with SLN sampling was
associated with shorter operative times and less bleeding and did not affect survival
at 2 years.
RÉSUMÉ
Objectif
Bien que l'utilisation du prélèvement du ganglion sentinelle (GS) soit relativement
récente dans la stadification du cancer de l'endomètre, il s'avère que cette méthode
donne des résultats très précis et est associée à peu de complications. Toutefois,
certaines études font état d'un faible taux de détection avec le prélèvement du GS
chez les patientes atteintes d'obésité. La présente étude vise à évaluer la faisabilité
du prélèvement du GS chez les patientes atteintes d'obésité ayant un cancer de l'endomètre
et à déterminer si l'omission du curage ganglionnaire dans la stadification chirurgicale
par prélèvement du GS a une incidence sur les issues oncologiques.
Méthodologie
Nous avons mené une étude rétrospective auprès de patientes atteintes d'obésité (IMC ≥ 35 kg/m2) ayant reçu un diagnostic de carcinome de l'endomètre entre 2007 et 2017 en comparant
les issues chirurgicales et oncologiques de 2 cohortes : les patientes ayant subi
un curage ganglionnaire et les patientes ayant subi un prélèvement du GS sans curage
ganglionnaire. Le critère de jugement principal était le temps opératoire. Les critères
de jugement secondaires comprenaient les saignements peropératoires, l'information
de l'analyse des ganglions lymphatiques, les événements indésirables peropératoires
et postopératoires et les issues oncologiques, notamment la survie sans progression
(SSP), la survie globale (SG) et la survie spécifique (SS). La SSP a été définie comme
le délai entre l'intervention chirurgicale et la récidive ou le décès, toutes causes
confondues. La SG a été définie comme le délai entre le diagnostic et le décès ou
la dernière date où l'on savait que la patiente était encore vivante, et la SS a été
définie comme le délai entre l'intervention chirurgicale et le décès des suites de
la maladie.
Résultats
Parmi les 223 patientes, dont l'IMC médian était de 40,6 kg/m2, 140 ont subi un curage ganglionnaire et 83 ont subi un prélèvement du GS seul. Le
temps opératoire médian pour les patientes du groupe de prélèvement du GS était plus
court que celui du groupe de curage ganglionnaire (190,5 [108-393] vs 238 [131-440]
min; p < 0,001), et le groupe de prélèvement du GS présentait une perte sanguine estimée
médiane inférieure à celle du groupe de curage ganglionnaire (30 [0-300] vs 40 [0-800]
ml; p = 0,03). Au seuil de suivi de 24 mois, 98 % des patientes étaient vivantes et 95,5 %
n’étaient pas atteintes de la maladie, sans différence significative quant à la SG,
à la SS et à la SSP entre les deux groupes (p = 0,7, p = 0,8 et p = 0,4, respectivement).
Conclusions
Chez les patientes atteintes d'obésité, l'omission du curage ganglionnaire dans la
stadification chirurgicale par prélèvement du GS était associée à un temps opératoire
plus court et à des saignements moins importants, et n'avait pas d'incidence sur la
survie à 2 ans.
Keywords
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Article info
Publication history
Published online: May 10, 2021
Footnotes
Disclosures: This work was made possible in part by grants from the Israel Cancer Research Fund, the Azrieli foundation, the Gloria's Girls Fund, the Susan and Jonathan Wener Fund, and the Anne-Marie and Mitch Garber Fund. The funding bodies had no role in the design of the study; collection, analysis, interpretation of data; or the writing of the manuscript.
All authors have indicated they meet the journal's requirements for authorship.
Identification
Copyright
© 2021 The Society of Obstetricians and Gynaecologists of Canada/La Société des obstétriciens et gynécologues du Canada. Published by Elsevier Inc. All rights reserved.
