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Cancers
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Lymph Node Dissection for Gynecologic Cancers
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Lymph Node Dissection for Gynecologic Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Methods and Technologies Development".

Deadline for manuscript submissions: 30 October 2024 | Viewed by 1783

Special Issue Editor

Dr. Fabio Landoni

E-Mail Website
Guest Editor
Gynecologic Oncology Unit, Department of Obstetrics and Gynecology, ASST-Monza, San Gerardo Hospital, University of Milano-Bicocca, 20900 Monza, Italy
Interests: ovarian cancer; oncology; surgery; gynecologic oncology; gynaecological surgery; hysterectomy; cancer prevention; laparoscopic surgery; gynecologic surgical procedures; pelvic reconstructive surgery

Special Issue Information

Dear Colleagues,

In this Special Issue, we will focus on the role of lymph node dissection (either sentinel lymph node or lymphadenectomy) for gynecological cancers.

In vulvar, endometrial, and cervical cancer, sentinel lymph node (SLN) mapping is becoming increasingly popular and is finding its application in everyday surgical practice. However, this is opening many new unanswered questions. The innovations in technique and the attempt to standardize it, the oncological meaning of isolated tumor cells and low-volume metastasis, the role of completion lymphadenectomy in positive sentinel lymph node cases, the possible use of sentinel node in fertility-sparing procedures, and, in general, the oncological safety of the SLN procedure are just some of the challenges we are facing in this new era.

Lymph node dissection has been recently tested in advanced-stage epithelial ovarian cancers. However, its role is still debated in early-stage epithelial and some non-epithelial ovarian cancers. The possible therapeutic benefit of lymphadenectomy is controversial, but it plays a role in staging, helping the clinician decide on adjuvant treatment. Recent studies suggest SLN as a possible procedure, but it is still experimental.

Additionally, the significant advances in imaging and molecular techniques are, in general, challenging this surgical procedure's role and helping in tailoring surgical and adjuvant treatment.

This Special Issue aims to give an up-to-date point of view on the role of lymph node dissection (either sentinel lymph node or lymphadenectomy) in treating all gynecological cancers in all settings (from fertility-sparing to radical surgery). We hope it will help in defying and stratifying the patients who will or will not benefit from this procedure. We also hope that it will give readers information about the impact of lymph node dissection on morbidities and patient-related outcomes, the choice of adjuvant treatments, and the diffusion of the different approaches in different healthcare systems.

Therefore, we are pleased to invite you to submit your original research or review articles for this Special Issue.

Research areas may include (but are not limited to) the following:

  • Vulvar cancer; vaginal cancer; cervical cancer; endometrial cancer; epithelial ovarian cancer; non-epithelial ovarian cancer; rare gynecological cancers.
  • Lymphadenectomy; sentinel lymph node; surgical technique.
  • Low volume metastasis (Isolated tumor cells and/or micrometastasis); Positive nodes in general.  
  • Imaging, molecular, clinical data to define patients who will benefit or not from lymph node dissection.
  • Role of lymph node dissection in the choice of adjuvant treatment.
  • Role of lymph node dissection in fertility-sparing treatments.
  • Role of lymph node dissection at the time of recurrence.

We look forward to receiving your contributions.

Dr. Fabio Landoni 
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Published Papers (2 papers)

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Review

17 pages, 873 KiB  
Review
Low-Volume Metastases in Apparent Early-Stage Endometrial Cancer: Prevalence, Clinical Significance, and Future Perspectives
by Diletta Fumagalli, Luigi A. De Vitis, Giuseppe Caruso, Tommaso Occhiali, Emilia Palmieri, Benedetto E. Guillot, Giulia Pappalettera, Carrie L. Langstraat, Gretchen E. Glaser, Evelyn A. Reynolds, Robert Fruscio, Fabio Landoni, Andrea Mariani and Tommaso Grassi
Cancers 2024, 16(7), 1338; https://doi.org/10.3390/cancers16071338 - 29 Mar 2024
Viewed by 758
Abstract
Endometrial cancer (EC) is the most diagnosed gynecologic malignancy, and its incidence and mortality are increasing. The prognosis is highly dependent on the disease spread. Surgical staging includes retroperitoneal evaluation to detect potential lymph node metastases. In recent years, systematic lymphadenectomy has been [...] Read more.
Endometrial cancer (EC) is the most diagnosed gynecologic malignancy, and its incidence and mortality are increasing. The prognosis is highly dependent on the disease spread. Surgical staging includes retroperitoneal evaluation to detect potential lymph node metastases. In recent years, systematic lymphadenectomy has been replaced by sentinel lymph node (SLN) biopsy and ultrastaging, allowing for the detection of macrometastases, micrometastases, and isolated tumor cells (ITCs). Micrometastases and ITCs have been grouped as low-volume metastases (LVM). The reported prevalence of LVM in studies enrolling more than one thousand patients with apparent early-stage EC ranges from 1.9% to 10.2%. Different rates of LVM are observed when patients are stratified according to disease characteristics and their risk of recurrence. Patients with EC at low risk for recurrence have low rates of LVM, while intermediate- and high-risk patients have a higher likelihood of being diagnosed with nodal metastases, including LVM. Macro- and micrometastases increase the risk of recurrence and cause upstaging, while the clinical significance of ITCs is still uncertain. A recent meta-analysis found that patients with LVM have a higher relative risk of recurrence [1.34 (95% CI: 1.07–1.67)], regardless of adjuvant treatment. In a retrospective study on patients with low-risk EC and no adjuvant treatment, those with ITCs had worse recurrence-free survival compared to node-negative patients (85.1%; CI 95% 73.8–98.2 versus 90.2%; CI 95% 84.9–95.8). However, a difference was no longer observed after the exclusion of cases with lymphovascular space invasion. There is no consensus on adjuvant treatment in ITC patients at otherwise low risk, and their recurrence rate is low. Multi-institutional, prospective studies are warranted to evaluate the clinical significance of ITCs in low-risk patients. Further stratification of patients, considering histopathological and molecular features of the disease, may clarify the role of LVM and especially ITCs in specific contexts. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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12 pages, 761 KiB  
Review
Low-Volume Metastases in Cervical Cancer: Does Size Matter?
by Tommaso Bianchi, Tommaso Grassi, Giampaolo Di Martino, Serena Negri, Gaetano Trezzi, Robert Fruscio and Fabio Landoni
Cancers 2024, 16(6), 1107; https://doi.org/10.3390/cancers16061107 - 9 Mar 2024
Viewed by 661
Abstract
The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN [...] Read more.
The implementation of sentinel lymph node (SLN) biopsy is changing the scenario in the surgical treatment of early-stage cervical cancer, and the oncologic safety of replacing bilateral pelvic lymphadenectomy with SLN biopsy is currently under investigation. Part of the undisputed value of SLN biopsy is its diagnostic accuracy in detecting low-volume metastases (LVM) via pathologic ultrastaging. In early-stage cervical cancer, the reported incidence of LVM ranges from 4 to 20%. The prognostic impact and the role of adjuvant treatment in patients with LVM is still unclear. Some non-prespecified analyses in prospective studies showed no impact on the oncologic outcomes compared to node-negative disease. However, the heterogeneity of the studies, the differences in the disease stage and the use of adjuvant treatment, and the concomitant pelvic lymphadenectomy (PLND) make reaching any conclusions on this topic hard. Current guidelines suggest considering micrometastases (MIC) as a node-positive disease, while considering isolated tumor cells (ITC) as a node-negative disease with a low level of evidence. This review aims to highlight the unanswered questions about the definition, identification, and prognostic and therapeutic roles of LVM and to underline the present and future challenges we are facing. We hope that this review will guide further research, giving robust evidence on LVM and their impacts on clinical practice. Full article
(This article belongs to the Special Issue Lymph Node Dissection for Gynecologic Cancers)
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