ABSTRACT
OBJECTIVE: The aim of this study was to determine progression-free survival (PFS) in patients with serous uterine carcinoma undergoing sentinel lymph node (SLN) mapping compared with patients undergoing standard lymphadenectomy. METHODS: We retrospectively reviewed all uterine cancer patients treated at our institution from 2005 to 2015. Patients were separated into two cohorts: those who underwent SLN mapping at the time of staging (SLN) and those who underwent routine lymphadenectomy (the non-SLN group). SLN mapping was performed according to institutional protocol, incorporating a surgical algorithm and pathologic ultrastaging. RESULTS: Overall, 248 patients were identified-153 SLN mappings and 95 routine lymphadenectomies (pelvic and/or paraaortic lymph node dissection). No significant difference in age or body mass index was observed between the groups (p = 0.08 and p = 0.9, respectively). Minimally invasive surgery was utilized in 117/153 (77%) SLN patients and 30/95 (32%) non-SLN patients (p = <0.001). Stage distribution for the SLN and non-SLN cohorts demonstrated 106/153 (69%) and 59/95 (62%) patients with stage I/II disease, respectively, and 47/153 (31%) and 36/95 (38%) patients with stage III/IV disease, respectively (p = 0.3). The median number of nodes removed was 12 (range, 1-50) in the SLN cohort versus 21 (range, 1-75) in the non-SLN cohort (p = <0.001). Adjuvant chemotherapy alone or with radiation therapy was administered in 122/153 (80%) SLN patients and 79/95 (83%) non-SLN patients; radiotherapy alone was administered in 12/153 (8%) SLN patients and 7/95 (7%) non-SLN patients (p = 0.8). At a median follow-up of 40 months, the 2-year PFS rates were 77% (95% confidence interval [CI], 68-83%) in the SLN group and 71% (95% CI, 61-79%) in the non-SLN group (p = 0.3). CONCLUSIONS: Incorporation of the SLN mapping algorithm into the staging of uterine serous cancer is feasible and does not appear to compromise prognosis. PFS in patients with uterine serous carcinoma undergoing SLN mapping, followed by adjuvant therapy, was similar to PFS in patients undergoing standard lymphadenectomy and adjuvant therapy.
Subject(s)
Cystadenocarcinoma, Serous/mortality , Lymph Node Excision/mortality , Lymph Nodes/surgery , Sentinel Lymph Node Biopsy/mortality , Sentinel Lymph Node/surgery , Uterine Cervical Neoplasms/mortality , Aged , Aged, 80 and over , Cystadenocarcinoma, Serous/pathology , Cystadenocarcinoma, Serous/surgery , Female , Follow-Up Studies , Humans , Lymph Nodes/pathology , Middle Aged , Neoplasm Staging , Retrospective Studies , Sentinel Lymph Node/pathology , Survival Rate , Uterine Cervical Neoplasms/pathology , Uterine Cervical Neoplasms/surgeryABSTRACT
OBJECTIVE: To assess the association of patient and nursing education on sequential compression device compliance in patients who have undergone major obstetric or benign gynecologic procedures. METHODS: We performed a prospective observational study on all English-speaking patients who underwent cesarean delivery or benign gynecologic surgery and were prescribed to wear sequential compression devices postoperatively at a university medical center. The 4-month study was divided into 1-month segments. The first month consisted of baseline observations of compliance. The second month was comprised of structured patient education, the third month involved nursing education, and the final month included both interventions. Observations were made twice daily. All educational interventions and observations were performed by two coauthors. A patient was noted to be compliant if she was ambulating, sitting, or lying in bed with sequential compression devices applied, tubing attached, and the machine powered on. RESULTS: A total of 859 observations was recorded for 228 patients. The number of hospitalization days ranged from 1 to 13 (mean 2.40 days, median 2 days). There was no difference in compliance among the months with 141 of 230 (61.3%), 106 of 194 (54.6%), 155 of 277 (56.0%), and 95 of 158 (60.1%) compliance for each consecutive month (P=.44). Noncompliance increased with each successive postoperative day (odds ratio 1.18 per day, 95% confidence interval 1.07-1.30). The most common patient-stated reason for noncompliance was "the nurse said I don't need them anymore" (82/362 observations [22.6%]). Overall, cesarean delivery was associated with the lowest rate of compliance when compared with gynecologic surgeries (272/519 [52.4%] compared with 225/340 [66.2%], P<.001). CONCLUSION: Compliance with postoperative use of sequential compression devices is approximately 58% and did not improve with patient or nursing educational interventions. LEVEL OF EVIDENCE: III.
