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- 저자 : Michihiro Tanikawa (검색결과 1 건)
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Lymphadenectomy issues in endometrial cancer
Yosuke Konno,Hiroshi Asano,Ayumi Shikama,Daisuke Aoki,Michihiro Tanikawa,Akinori Oki,Koji Horie,Akira Mitsuhashi,Akira Kikuchi,Hideki Tokunaga,Yasuhisa Terao,Toyomi Satoh,Kimio Ushijima,Mitsuya Ishika 대한부인종양학회 2021 Journal of Gynecologic Oncology Vol.32 No.2
Objectives: This review aims to introduce preoperative scoring systems to predict lymphnode metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role oflymphadenectomy for endometrial cancer. Methods: We summarized previous reports on the preoperative prediction models forLNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, wecompared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) toexamine the survival benefit of lymphadenectomy in endometrial cancer, and described thedetails of JCOG1412. Results: Lymphadenectomy has been omitted for 64 endometrial cancer patients who met low risk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphaticfailure has been observed. Other two models also produced comparable results. Two randomizedphase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrialcancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aorticlymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients atrisk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, includinglower limit of the number of resected nodes, and submission of photos of dissected area toevaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showedthat the quality of lymphadenectomy has been well-controlled in JCOG1412. Conclusion: Our strategy seems reasonable to omit lymphadenectomy and could begeneralized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms ofthe quality of surgical procedures, which would draw the bona-fide conclusions regarding thetherapeutic role of lymphadenectomy for endometrial cancer.
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