Management of lymph nodes in the treatment of gynecologic cancers

Abstract

adenectomy as part of the surgery. Although the paraaortic lymph nodes are the primary nodes for the metastasis of endometrial cancer, it is still controversial how to manage them surgically. Because pelvic lymphadenectomy causes lymphedema in the lower leg and lymphatic cysts in the pelvis in a substantial proportion of patients, it seems to be of importance to attempt exploration of a sentinel lymph node. However, in contrast to conditions in vulvar cancer, the accuracy of determining the sentinel lymph node is not yet satisfactory, because of the variety of distribution of lymph vessels in the pelvis. As many studies have reported that lymph node metastasis could be a strong prognostic factor in both cervical and endometrial cancer, the treatment of patients with lymph node metastasis is the greatest issue for uterine cancer. Of note, however, lymph node metastases in patients with uterine cancer have been treated with postoperative radiation. In ovarian cancer, because peritoneal dissemination was believed to be the main route of cancer cell spread, not much attention had been paid to lymph node metastasis, until the 1980s, when systematic surgical explorations of retroperitoneal lymph nodes revealed that a substantial proportion of patients with ovarian cancer, even those without intraperitoneal spread, had lymph node metastasis. However, the extent of intraperitoneal disease in ovarian cancer still seems to be regarded as the most important prognostic factor for patients receiving postoperative chemotherapy, and the importance of the management of retroperitoneal lymph nodes during primary surgery has not yet been recognized. It remains to be established whether the best course of action for exploring lymph nodes in patients with ovarian cancer is by surgery, biopsy, or dissection. The Japan Society of Gynecologic Oncology (JSGO) is publishing the fi rst edition of their guidelines for the treatment of cervical cancer and endometrial cancer, and the Society is preparing a revised edition of the guidelines for the treatment of ovarian cancer. This review should be useful to aid in our understanding of the section in the guidelines that deals with the management of lymph nodes in the treatment of gynecologic cancers. Received: April 6, 2007