title: Does debulking of enlarged positive lymph nodes improve survival in different gynaecological cancers?
abstract: Lymph-node-positive gynaecological cancers remain a pharmacotherapeutic challenge, and patients with lymph-node-positive gynaecological cancers have poor survival. The purpose of this review is to determine whether a survival advantage arises from surgical debulking of enlarged positive lymph nodes in different types of gynaecological cancers. Information from studies published on the survival benefits from debulking lymph nodes in gynaecological cancers was investigated. Pertaining to therapeutic lymphadenectomy, survival benefit can be analysed in two ways, direct survival benefit following therapeutic lymphadenectomy of bulky positive metastatic lymph nodes and indirect survival benefit, which results after a sequela of systematic lymphadenectomy, proper, accurate staging of disease and stage migration and tailor-made adjuvant treatment. The direct hypothesis of therapeutic lymphadenectomy and survival benefit has been prospected in cervical cancers and vulval cancers and in post-chemotherapy residual paraarotic nodal mass in germ cell ovarian cancer. The indirect survival benefit of therapeutic paraarotic lymphadenectomy in high-risk endometrial cancers and advanced epithelial ovarian cancers needs to be tested in randomized controlled trials. More randomized controlled trials are required to investigate this research question. Further, indirect benefit due to tailor-made adjuvant treatment, secondary to accurate staging achieved as a sequela of systematic lymphadenectomy, needs to be analysed in future trials.
authors.affiliation: Manipal Comprehensive Cancer Center, Manipal Hospital, Bangalore 560017, India. Electronic address: somusp@yahoo.com.
authors.forename: S P
authors.initials: SP
authors.lastname: Somashekhar
mesh_terms: D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D000077216:Carcinoma, Ovarian Epithelial; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000601:surgery*; D065426:Cytoreduction Surgical Procedures; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery; D005260:Female; D005833:Genital Neoplasms, Female / Q000473:pathology / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D009367:Neoplasm Staging; D009373:Neoplasms, Germ Cell and Embryonal / Q000473:pathology / Q000601:surgery; D009375:Neoplasms, Glandular and Epithelial / Q000473:pathology / Q000601:surgery; D010051:Ovarian Neoplasms / Q000473:pathology / Q000601:surgery; D011379:Prognosis; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000473:pathology / Q000601:surgery
keywords: cervical cancer; debulking; endometrial cancer; germ cell cancer; gynaecological cancer; lymph node