There was an ongoing discussion over the surgical management of gynecological cancers with isolated lymph node recurrence (ILNR). Few studies have examined the viability and efficacy of minimally invasive lymphadenectomy, however, it was unknown what the maximum tumor size that can be treated with this method. For a study, researchers sought to determine the safety and viability of resecting big tumors with a less invasive technique while prospectively analyzing ILNR patients treated by laparoscopy in the center.

A prospective observational case-series investigation was conducted. To evaluate the safety and viability of such a surgical procedure, they included all consecutive patients with ILNR from gynecological malignancies who underwent minimally invasive lymphadenectomy at the facility from June 2013 to June 2021. They also assessed the oncological outcome in terms of survival, location of recurrence, and further recurrence.

There were 27 patients with ILNR caused by gynecological malignancies (ovarian cancer, 12; uterine malignancies, 12; cervical cancer, 3). Three of these instances, which served as exemplars, had LNs that were exceptionally large—up to 8 cm—and have been described in detail along with films of the surgical operation. The aortic region (67%) had the most ILNR. No operation was modified to open surgery; all recurrent LNs were entirely removed. Twenty-four months was the median amount of time for follow-up. A new recurrence occurred in 10 patients (about 37%). Five patients (18.5%) had died, 4 (14.8%) were alive but showed signs of the illness, and 18 (66.7%) were living but showed no signs of the illness.

Even for big tumors, minimally invasive surgery for ILNR in gynecological malignancies may be a viable, safe, and successful choice in terms of oncological outcomes. In the framework of an ideal multimodal treatment strategy, it also permitted a speedier recovery with the early start of suitable postoperative systemic chemotherapy.

Reference: sciencedirect.com/science/article/pii/S1743919122005210