Oncologic impact of micrometastases or isolated tumor cells in sentinel lymph nodes of patients with endometrial cancer: a meta-analysis.

PURPOSE: There is a gap in knowledge regarding the impact of micrometastases (MIC) and isolated tumor cells (ITCs) found in the sentinel lymph nodes of patients with endometrial cancer. Here, we present a meta-analysis of the published literature on the rate of MIC and ITCs after lymphatic mapping and determine trends in postoperative management. METHODS: Literature search of Medline and PubMed was done using the terms: micrometastases, isolated tumor cells, endometrial cancer, and sentinel lymph node. Inclusion criteria were: English-language manuscripts, retrospectives, or prospective studies published between January 1999 and June 2019. We removed manuscripts on sentinel node mapping that did not specify information on micrometastases or isolated tumor cells, non-English-language articles, no data about oncologic outcomes, and articles limited to ten cases or less. RESULTS: A total of 45 manuscripts were reviewed, and 8 studies met inclusion criteria. We found that the total number of patients with MIC/ITCs was 286 (187 and 99, respectively). The 72% of patients detected with MIC/ITCs in sentinel nodes received adjuvant therapies. The MIC/ITCs group has a higher relative risk of recurrence of 1.34 (1.07, 1.67) than the negative group, even if the adjuvant therapy was given. CONCLUSION: We noted that there is an increased relative risk of recurrence in patients with low-volume metastases, even after receiving adjuvant therapy. Whether adjuvant therapy is indicated remains a topic of debate because there are other uterine factors implicated in the prognosis. Multi-institutional tumor registries may help shed light on this important question.

[Hepatic complications in the postoperative of cardiac surgery]. / Complicaciones hepáticas en el postoperatorio de la cirugía cardíaca.

In a study of fifty patients subjected to cardiac surgery nine (18%) had immediate post-operative liver complications. These included persistente jaundice, an increase in hepatomegaly and elevation of the alkaline phosphatase. In these and the rest of the cases there were extra-hepatic complications such as hyposystole, infarct, the post-pericardiotomy syndrome as related to the heart. Pulmonary complications were of infectious nature and a general complication was sepsis. These complications were sufficiently important to relate them etiologically to the hepatic disorder. Especially important is right hyposystole and it or tricuspid insufficiency can be blamed for the hepatic disorder in some of these patient. Nonetheless, these hepatic complications are seen less frequently now that we are giving effective treatment to the tricuspid insufficiency during the surgical intervention. We observed the clinical picture known as "benign postoperative cholestasis" in only two patients. Hepatitis with jaundice was seen in four patients during one to three months postoperatively. This was HB hepatitis and its course was more prolonged than that usually seen in Mexico, and it turned into chronic hepatitis in four patients. Biopsies done in one case a six months and in the other at nine months post-operatively showed the picture of chronic aggresive hepatitis. In those patients who did not have hepatic complications a late liver evaluation showed an improvement as compared to the pre-operative condition which was parallel to the hemodynamic improvement.