Staging Flashcards
Why do you do lymph nodes when two randomize controlled trials from Europe reported that lymph node dissection routinely does not improve outcomes?
The studies have limitations including Extent of lymph node dissection, selection of patients, and lack of standardization of postop therapy. There were also concerns of lack of central Pathology, GYN oncologist, and adequacy of statistical power
When do you do para aortic lymph node dissection?
Grade 3 lesions, pelvic or adnexal disease, or when pelvic or para-aortic lymph nodes are suspicious. Also if deeply invasive.
What are the intraoperative frozen section findings that may make you not perform lymph nodes?
Less than 50%, tumor less than 2 cm, grade one.
What is the percentage of tumors that are upgraded frozen?
20%. And if your grade increases the accuracy of intraoperative determination of invasion decreases. In one study, the depth of invasion was accurately determined in 87% of grade 1, 65% of grade 2, and 30% of grade 3.
Why do you do lymph nodes at all?
To guide appropriate adjuvant therapy
What is your superior border of your periaortic lymphadenectomy?
IMA. However in a recent study from the Mayo Clinic in 2014, 88% are located in the high para-aortic area, and 35% of the time this area is the only site para aortic involvement. With negative nodes and no extrauterine disease, para-aortic spread is rare except for grade 2 and 3 with deep MI
What are the eight lymphatic basins in the pelvis? And the four basins in the para-aortic region?
In the pelvis there are bilateral common iliac, external iliac, internal iliac, and obturator. In the para-aortic region there are bilateral infra IMA and then up to the renal veins
What is the percentage of patients with negative pelvic lymph nodes have positive aortic? What is the percentage and positive pelvic nodes?
3% (data from Mayo Clinic in 2014 ). Roughly half of the cases with positive pelvic lymph nodes will have spread to the periaortic nodes. When para-aortic lymph nodes are positive and the pelvic nodes are negative, they are most likely found in the high para-aortic region (67%)
What do you do when pelvic another positive and negative lower periaortic nodes
And 12% of the patients they will still have occult hi para-aortic lymph nodes.
Lymph nodes for sarcoma
No
Do you restage unstaged patients?
If High risk features, then I first obtain imaging, and then I offer/ discuss staging in order to help guide adjuvant treatment
Lap2, conversion rate? Rate of pelvic and para aortic not removed
This study compared laparoscopy laparotomy in stage I-II A cancers:
25% conversion rate
Public and para-aortic nodes were not removed and 8% in laparoscopy and 4% of laparotomy
In lap2, what were the complications?
There was no difference in Intraoperative complications. Postop, complications with more in laparotomy(ileus, cardiac, infection needing abx) no diff in reop, readmission, death. LOS < in lap.
