I期子宫内膜癌巴结切除有必要吗

1、i期子宫内膜癌淋巴结切除有必要吗北京大学人民医院妇产科 王建六妇科常见肿瘤诊治指南 中华医学会妇科肿瘤分会 p49i期子宫内膜癌应行手术分期术式为筋膜外子宫切除术及双附件切除术 盆腔及腹主动脉旁淋巴结切除和（或）取样术术中如无明显淋巴结肿大，应系统切除淋巴结术中有可疑淋巴结肿大，取样明确有无转移即可腹主动脉旁淋巴结切除/取样指征： 可疑淋巴结转移 特殊组织类型 ca125显著升高 宫颈受累深肌层受累 低分化全国高等院校教材 妇产科学 乐杰主编 林仲秋编写 p275i期子宫内膜癌应行筋膜外子宫切除术及双附件切除术 盆腔及腹主动脉旁淋巴结切除和（或）取样术下列情况之一，应行盆腔及腹主动脉旁淋巴结切

2、除和（或）取样术可疑淋巴结增大 宫颈受累 ca125显著升高特殊组织类型 癌灶累及宫腔面积超过50% 低分化 深肌层受累 cochrane database syst rev. 2010 jan 20;(1):cd007585.lymphadenectomy for the management of endometrial cancer.may k, bryant a, dickinson ho, kehoe s, morrison j university of oxford, womens centre no evidence that lymphadenectomy decreases

3、 the risk of death or disease recurrence compared with no lymphadenectomy in women with presumed stage i disease. the evidence on serious adverse events suggests that women who receive lymphadenectomy are more likely to experience surgically related systemic morbidity or lymphoedema/lymphocyst forma

4、tion.j natl cancer inst. 2008 dec 3;100(23):1707-16. epub 2008 nov 25systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial.rome, italy conclusion: although systematic pelvic lymphadenectomy statistically significantly improved surgic

5、al staging, it did not improve disease-free or overall survival.lancet. 2009 jan 10;373(9658):125-36. epub 2008 dec 16.efficacy of systematic pelvic lymphadenectomy in endometrial cancer (mrc astec trial): a randomised study.collaborators (180) amos c, blake p, branson a, buckley ch, redman cw, shep

6、herd j, dunn g, heintz p, yarnold j, johnson p, mason m, rudd r, badman p, begum s, chadwick n, collins s, goodall k, jenkins j, law k, mook p, sandercock j, goldstein c, uscinska b, cruickshank m, parkin de, crawford ra, latimer j, michel m, clarke j, dobbs s, mcclelland rj, price jh, chan kk, mann

7、 c, rand r, fish a, lamb m, goodfellow c, tahir s, smith jr, gornall r, kerr-wilson r, swingler gr, lavery ba, chan kk, kehoe s, flavin a, eddy j, davies-humphries j, hocking m, sant-cassia lj, pearson s, chapman rl, hodgkins j, scott i, guthrie d, persic m, daniel fn, yiannakis d, alloub mi, gilber

8、t l, heslip mr, nordin a, smart g, cowie v, katesmark m, murray p, eddy j, gornall r, swingler gr, finn cb, moloney m, farthing a, hanoch j, mason pw, mcindoe a, soutter wp, tebbutt h, morgan js, vasey d, cruickshank dj, nevin j, kehoe s, mckenzie iz, gie c, davies q, ireland d, kirwan p, davies q,

9、lamb m, kingston r, kirwan j, herod j, fiander a, lim k, head ac, lynch cb, browning aj, cox c, murphy d, duncan id, mckenzie c, crocker s, nieto j, paterson me, tidy j, duncan a, chan s, williamson km, weekes a, adeyemi oa, henry r, laurence v, dean s, poole d, lind mj, dealey r, godfrey k, hatem m

10、m, lopes a, monaghan jm, naik r, evans j, gillespie a, paterson me, tidy j, ind t, lane j, oates s, redford d, ford m, fish a, larsen-disney p, johnson n, bolger a, keating p, martin-hirsch p, richardson l, murdoch jb, jeyarajah a, lamb m, mcwhinney n, farthing a, mason pw, kitchener h, beynon jl, h

11、ogston p, low em, woolas r, anderson r, murdoch jb, niven pa, kerr-wilson r, chin k, flynn p, freites o, newman gh, mcnally o, cullimore j, olaitan a, mould t, menon v, redman cw, george m, hatem mh, evans a, fiander a, howells r, lim k, cawdell g, warwick ap, eustace d, giles j, leeson s, nevin j,

12、van wijk al, karolewski k, klimek m, blecharz p, mcconnell d. hysterectomy and bilateral salpingo-oophorectomy (bso) is the standard surgery for stage i endometrial cancer. systematic pelvic lymphadenectomy has been used to establish whether there is extra-uterine disease and as a therapeutic proced

13、ure median follow-up of 37 months (iqr 24-58) 191 women had died: 88/704 standard surgery group 103/704 lymphadenectomy group251recurrent disease 107/704 standard surgery group 144/704 lymphadenectomy group) interpretationno evidence of benefit in terms of overall or recurrence-free survival for pel

14、vic lymphadenectomy in women with early endometrial cancer.pelvic lymphadenectomy cannot be recommended as routine procedure for therapeutic purposes outside of clinical trials.术前b超、mri等估计深肌层受侵术前病理分级为g3术前临床分期ii期以上术中探查腹膜后淋巴结可疑转移术中发现侵肌1/2术中发现宫腔50%以上有病灶累及子宫内膜浆乳癌、透明细胞癌等淋巴结切除范围一定要切除腹主动脉旁淋巴结吗？一定要切除腹主动脉旁淋巴

15、结吗？eur j gynaecol oncol. 2007;28(2):98-102. prince of wales hospital, shatin, hong kong is aortic lymphadenectomy necessary in the management of endometrial carcinoma?75 (46.0%) pelvic lymphadenectomy alone 88 (54.0%) had both pelvic and aortic lymphadenectomy35 (21.5%) nodal metastases positive pel

16、vic 26 (16.0%)positive aortic 24 (27.3%) isolated aortic metastases 17 cases (19.3%) 35 patients with nodal metastases recurrence developed in 15 (42.9%) and all except one died within five to 50 monthsthe recurrence rate was higher (63.6%) among patients with upper aortic lymph node metastasesall t

17、hose who recurred died of disease within seven to 28 months. conclusionsaortic lymphadenectomy provides both diagnostic and therapeutic value in the management of endometrial carcinoma with high metastatic risk. todo y et al.survival effect of para-aortic lymphadenectomy in endometrial cancer (sepal study): a retrospective cohort analysis. lancet. 2010 apr 3;375(9721):1165-72 671 patients with endometrial carcinomasystematic pelvic lymphadenectomy (n=325)pelvic and para-aortic