Author/Editor		Takač, Iztok; Arko, Darja; Bali, Robert; Čas-Sikošek, Nina; Gorišek, Borut; Zukanović, Dunja
Title		Pomen limfadenektomije pri raku endometrija
Translated title		The role of lymphadenectomy in endometrial cancer
Type		članek
Source		Zdrav Vestn
Vol. and No.		Letnik 72, št. Suppl 2
Publication year		2003
Volume		str. II-43-6
Language		slo
Abstract		Background. Lymphatics are the main pathway for distant spread of endometrial cancer. The node groups most commonly involved are located along the iliac and retroperitoneal vessels. Therefore, pelvic and aortic lymphadenectomy are performed for staging and therapeutic purposes. Methods. Lymphadenectomy is indicated in patients having moderate to high risk for lymph node metastasis (grade 2 and 3 tumor, myoinvasion >50%, clear cell, squamous and serous papillary tumors). In patients with low risk for node metastasis (myometrial invasion absent or <50% with grades 1 lymphadenectomy is questionable. Patterns of lymphatic spread indicate that lymphadenectomy should include superficial obturator, external iliac, and common iliac nodes. Internal iliac, deep obturator, deep common iliac, presacral and aortic nodes should be removed only from patients having node metastases at frozen section. Conclusions. A thorough staging lymphadenectomy provides more accurate information to select patients who are candidates for adjuvant treatment. The main role of this procedure is in individualized tailoring of adequate adjuvant treatment.
Summary		Izhodišča. Limfogeno širjenje je glavni način razsoja raka endometrija. Bezgavke, v katere rak najpogosteje zaseva, se nahajajo ob medeničnih in retroperitonejskih žilah. Pelvična in aortna limfadenektomija se zato izvajata zaradi opredelitve razširjenosti raka, a tudi zaradi odstranitve rakastih celic. Metode. Limfadenektomija je indicirana pri bolnicah s srednjim in visokim tveganjem za prisotnost zasevkov v bezgavkah, kamor sodijo zmerno in slabo diferencirani tumorji, tumorji s prodorom v več kot polovico debeline miometrija, tumorji, ki se širijo v vrat maternice, ter svetlocelični, skvamozni in serozno papilarni tumorji. Pri bolnicah z nizkim tveganjem za prisotnost zasevkov v bezgavkah (dobro diferencirani tumorji, tumorji brez invazije ali z invazijo do polovice debeline miometrija) pomen limfadenektomije ni jasen. Zaradi načina limfogenega širjenja je potrebno odstraniti povrhnje obturatorne, zunanje iliakalne ter skupne iliakalne bezgavke. Notranje iliakalne, globoke obturatorne, globoke skupne iliakalne, presakralne in aortne bezgavke je potrebno odstraniti le pri bolnicah, pri katerih z zmrzlim rezom potrdimo zasevke v bezgavkah. Zaključki. Natančna limfadenektomija omogoča izbiro bolnic, pri katerih je potrebno dopolnilno zdravljenje. Njena poglavitna vloga je individualna prilagoditev ustreznega načina dopolnilnega zdravljenja.
Descriptors		ENDOMETRIAL NEOPLASMS LYMPH NODE EXCISION PELVIS AORTA