Lymphadenectomy Archives - Revista Brasileira de Ginecologia e Obstetrícia
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):632-639
Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(11):632-639
Axillary web syndrome is characterized as a physical-functional complication that impacts the quality of life of women who have undergone treatment for breast cancer. The present study aims to verify the physiotherapy treatment available for axillary web syndrome after surgery for breast cancer in the context of evidence-based practice. The selection criteria included papers discussing treatment protocols used for axillary web syndrome after treatment for breast cancer. The search was performed in the MEDLINE, Scopus, PEDro and LILACS databases using the terms axillary web syndrome, lymphadenectomy and breast cancer, focusing on women with a previous diagnosis of breast cancer who underwent surgery with lymphadenectomy as part of their treatment. From the 262 studies found, 4 articles that used physiotherapy treatment were selected. The physiotherapy treatment was based on lymphatic drainage, tissue mobilization, stretching and strengthening. The four selected articles had the same outcome: improvement in arm pain and shoulder function and/or dissipation of the axillary cord. Although axillary web syndrome seems to be as frequent and detrimental as other morbidities after cancer treatment, there are few studies on this subject. The publications are even scarcer when considering studies with an interventional approach. Randomized controlled trials are necessary to support the rehabilitation resources for axillary web syndrome.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):35-39
Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2017;39(1):35-39
Robotic surgeries for cervical cancer have several advantages compared with lapa-rotomic or laparoscopic surgeries. Robotic single-site surgery has many advantages compared with the multiport approach, but its safety and feasibility are not established in radical oncologic surgeries. We report a case of a Federation of Gynecology and Obstetrics (FIGO) stage IB1 cervical carcinoma whose radical hysterectomy, sentinel lymph node mapping, and lymph node dissection were entirely performed by robotic single-site approach. The patient recovered very well, and was discharged from the hospital within 24 hours.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2015;37(7):308-313
DOI 10.1590/S0100-720320150005343
To estimate the likelihood of axillary lymph node involvement for patients with early-stage breast cancer, based on a variety of clinical and pathological factors.
A retrospective analysis was done in hospital databases from 1999 to 2007. Two hundred thirty-nine patients were diagnosed with early-stage breast cancer. Predictive factors, such as patient age, tumor size, lymphovascular invasion, histological grade and immunohistochemical subtype were analyzed to identify variables that may be associated with axillary lymph node metastasis.
Patients with tumors that are negative for estrogen receptor, progesterone receptor, and HER2 had approximately a 90% lower chance of developing lymph node metastasis than those with luminal A tumors (e.g., ER+ and/or PR+ and HER2-) - Odds Ratio: 0.11; 95% confidence interval: 0.01-0.88; p=0.01. Furthermore, the risk for lymph node metastasis of luminal A tumors seemed to decrease as patient age increased, and it was directly correlated with tumor size.
The molecular classification of early-stage breast cancer using immunohistochemistry may help predicting the probability of developing axillary lymph node metastasis. Further studies are needed to optimize predictions for nodal involvement, with the aim of aiding the decision-making process for breast cancer treatment.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 1999;21(1):41-45
DOI 10.1590/S0100-72031999000100007
Purpose: to demonstrate a new approach to treatment of endometrial cancer. Methods: Between February, 1996 and February, 1998, twelve patients with endometrial cancer, diagnosed by hysteroscopy and biopsy, were submitted to pelvic lymphadenectomy and hysterectomy with salpingo-oophorectomy by laparoscopy. The mean age was 58.1 years, the mean number of gestations was 2.3 and the mean body mass index was 28.6. Results: the mean length of anesthesia was 4.8 hours. The mean time of hospital stay was 3.3 days. The total of lymph nodes obtained was 176, 104 (59.1%) being from the right side and 72 (40.9%) from the left side. The mean of lymph nodes per patient was 18.5. We observed two complications: in one case the laparoscopic procedure had to be abandoned because the patient presented a dangerous increase in intratracheal pressure and in the other case a granuloma in the vagina was observed. Conclusions: the initial evaluation of the laparoscopic hysterectomy and laparoscopy shows that we achieved good results regarding the accuracy of staging, the number of nodes and a small number (3) of complications.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(7):479-484
DOI 10.1590/S0100-72032002000700008
Purpose: to evaluate the lymphoscintigraphy, the hand-held probe and the vital blue dye to identify the sentinel lymph node (SLN) in breast carcinoma and to establish sensitivity, negative predictive value (NPV) and overall accuracy of the SLN detection. Methods: eighty-eight consecutive attended patients, with clinically negative axillary lymph nodes were enrolled for this study using the technique of mapping with 99m technetium dextran for scintigraphic images before surgery. In the operating room, five minutes before axillary incision, we injected 2 mL of 2.5% Bleu Patente V Sodique around the tumor and intradermally. Then the gamma probe helped to find out the hot spot where the SLN was supposed to be. The pathologic results of SLN were obtained by the standard technique with hematoxylin and eosin staining in seventy-seven patients. Results: scintigraphy was conclusive for lymphatic basins in 62.1% of 58 cases, concerning SLN identification. In these conclusive patients, there were 9 in which 2 nodes appeared simultaneously without lymph vessel delineation. Using the gamma probe, at least one axillary SLN site could be found preoperatively in 45 cases (84.9%), and intraoperatively, associated with blue dye, in all 53 patients. In 32 of 35 patients only vital blue dye was used with success. Concerning the groups "day" and "other day" (when biopsy was performed on the same day or the other day, after the radiolabeled injection), therefore different regarding time and gamma counts, both achieved the same results regarding SLN detection. Forty-one patients had positive axillary lymph nodes and only two had false negative SLN, giving sensitivity of 95.3%, a NPV of 95.5% and overall accuracy of 97.7%. Conclusions: the lymph node mapping with the use of technetium and patent blue V, alone or associated, is feasible. The time since the injection of technetium up to surgery varied from 3 to 17 h. The pathologic findings confirmed that the biopsied lymph node was the true sentinel node in 97.6% of the cases and validated the SLN mapping, and this should lead to an avoidance of complete axillary dissection as a routine procedure in patients with negative SLN.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(4):221-226
DOI 10.1590/S0100-72032002000400002
Purpose: to evaluate the relationdhip between preservation of the intercostobrachial nerve and pain sensitivity of the arm, total time of the surgery, and number of dissected nodes in patients submitted to axillary lymphadenectomy due to breast cancer. Methods: an intervention, prospective, randomized and double-blind study was performed on 85 patients assisted at the State University of Campinas, Brazil, from January 1999 to July 2000. The patients were divided into two groups, according to the intention of preserving or not the intercostobrachial nerve. The surgeries were performed by the same researchers, utilizing the same technique. The postoperative evaluations were performed within 2 days, 40 days and after 3 months. The pain sensitivity of the arm was evaluated through a specific questionnaire (subjective evaluation) and through a neurological physical examination (objective evaluation). Results: the surgical technique was applied to all patients and the preservation of the intercostobrachial nerve was related to a significant decrease in the alterations of pain sensitivity of the arm, both by the subjective and objective evaluations. After three months, in the subjective evaluation, 61% of the patients were asymptomatic in the intercostobrachial nerve preservation group and 28.6% in the nerve section group (p<0.01). By the objective evaluation, 53.7% of the patients presented normal neurological examination in the intercostobrachial nerve preservation group and 16.7% in the nerve section group (p<0.01). No significant difference was observed regarding total time of surgery (p=0.76) and number of dissected nodes between the two evaluated groups (p=0.59). Conclusions: these data show that the preservation of the intercostobrachial nerve is feasible and leads to a significant decrease in the alterations of pain sensitivity of the arm, without interfering in the total time of surgery and the number of dissected nodes.
Summary
Revista Brasileira de Ginecologia e Obstetrícia. 2002;24(4):221-226
DOI 10.1590/S0100-72032002000400002
Purpose: to evaluate the relationdhip between preservation of the intercostobrachial nerve and pain sensitivity of the arm, total time of the surgery, and number of dissected nodes in patients submitted to axillary lymphadenectomy due to breast cancer. Methods: an intervention, prospective, randomized and double-blind study was performed on 85 patients assisted at the State University of Campinas, Brazil, from January 1999 to July 2000. The patients were divided into two groups, according to the intention of preserving or not the intercostobrachial nerve. The surgeries were performed by the same researchers, utilizing the same technique. The postoperative evaluations were performed within 2 days, 40 days and after 3 months. The pain sensitivity of the arm was evaluated through a specific questionnaire (subjective evaluation) and through a neurological physical examination (objective evaluation). Results: the surgical technique was applied to all patients and the preservation of the intercostobrachial nerve was related to a significant decrease in the alterations of pain sensitivity of the arm, both by the subjective and objective evaluations. After three months, in the subjective evaluation, 61% of the patients were asymptomatic in the intercostobrachial nerve preservation group and 28.6% in the nerve section group (p<0.01). By the objective evaluation, 53.7% of the patients presented normal neurological examination in the intercostobrachial nerve preservation group and 16.7% in the nerve section group (p<0.01). No significant difference was observed regarding total time of surgery (p=0.76) and number of dissected nodes between the two evaluated groups (p=0.59). Conclusions: these data show that the preservation of the intercostobrachial nerve is feasible and leads to a significant decrease in the alterations of pain sensitivity of the arm, without interfering in the total time of surgery and the number of dissected nodes.