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Description of a reproducible anatomically based surgical algorithm for detection of pelvic sentinel lymph nodes in endometrial cancer

Persson, Jan LU ; Geppert, Barbara LU ; Lönnerfors, Céline LU ; Bollino, Michele and Måsbäck, Anna LU (2017) In Gynecologic Oncology 147(1). p.120-125
Abstract

Objective: To describe and evaluate a reproducible, anatomically based surgical algorithm, including reinjection of tracer to enhance technical success rate, for detection of pelvic sentinel lymph nodes (SLNs) in endometrial cancer (EC). Methods: A prospective study of 102 consecutive women with high risk EC scheduled for robotic surgery was conducted. Following cervical injection of a fluorescent dye, an algorithm for trans- and retroperitoneal identification of tracer display in the lower and upper paracervical pathways was strictly adhered to. To enhance the technical success rate, this included ipsilateral reinjection of tracer in case of non-display of any lymphatic pathway. The lymphatic pathways were kept intact by opening the... (More)

Objective: To describe and evaluate a reproducible, anatomically based surgical algorithm, including reinjection of tracer to enhance technical success rate, for detection of pelvic sentinel lymph nodes (SLNs) in endometrial cancer (EC). Methods: A prospective study of 102 consecutive women with high risk EC scheduled for robotic surgery was conducted. Following cervical injection of a fluorescent dye, an algorithm for trans- and retroperitoneal identification of tracer display in the lower and upper paracervical pathways was strictly adhered to. To enhance the technical success rate, this included ipsilateral reinjection of tracer in case of non-display of any lymphatic pathway. The lymphatic pathways were kept intact by opening the avascular planes. To minimize disturbance from leaking dye, removal of SLNs was first performed along the lower paracervical (presacral) pathways followed by the more caudal upper paracervical pathways. In each pathway, the juxtauterine node with an afferent lymph vessel was defined as an SLN. After removal of SLNs, a complete pelvic and, unless contraindicated, infrarenal paraaortic lymph node dissection was performed. Results: The bilateral detection rate including tracer reinjection was 96%. All 24 (23.5%) node positive patients had at least one metastatic SLN. Presacral lymph node metastases were discovered in 33.3% of the node positive patients. One patient (4.2%) had an isolated presacral lymph node metastasis. Conclusions: The described cranial-to-caudal anatomically based surgical SLN algorithm, including a presacral dissection and reinjection of tracer, results in a high SLN detection rate and identified all patients with lymph node metastases.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Anatomy, Endometrial cancer, Indocyanine green, Lymphadenectomy, Lymphatic metastases, Lymphatic system, Sentinel lymph node biopsy
in
Gynecologic Oncology
volume
147
issue
1
pages
120 - 125
publisher
Academic Press
external identifiers
  • scopus:85025457064
ISSN
0090-8258
DOI
10.1016/j.ygyno.2017.07.131
language
English
LU publication?
yes
id
30bcb20d-7efb-4b24-9d2d-7ae4d1f7e091
date added to LUP
2017-08-30 14:51:00
date last changed
2017-10-06 14:50:48
@article{30bcb20d-7efb-4b24-9d2d-7ae4d1f7e091,
  abstract     = {<p>Objective: To describe and evaluate a reproducible, anatomically based surgical algorithm, including reinjection of tracer to enhance technical success rate, for detection of pelvic sentinel lymph nodes (SLNs) in endometrial cancer (EC). Methods: A prospective study of 102 consecutive women with high risk EC scheduled for robotic surgery was conducted. Following cervical injection of a fluorescent dye, an algorithm for trans- and retroperitoneal identification of tracer display in the lower and upper paracervical pathways was strictly adhered to. To enhance the technical success rate, this included ipsilateral reinjection of tracer in case of non-display of any lymphatic pathway. The lymphatic pathways were kept intact by opening the avascular planes. To minimize disturbance from leaking dye, removal of SLNs was first performed along the lower paracervical (presacral) pathways followed by the more caudal upper paracervical pathways. In each pathway, the juxtauterine node with an afferent lymph vessel was defined as an SLN. After removal of SLNs, a complete pelvic and, unless contraindicated, infrarenal paraaortic lymph node dissection was performed. Results: The bilateral detection rate including tracer reinjection was 96%. All 24 (23.5%) node positive patients had at least one metastatic SLN. Presacral lymph node metastases were discovered in 33.3% of the node positive patients. One patient (4.2%) had an isolated presacral lymph node metastasis. Conclusions: The described cranial-to-caudal anatomically based surgical SLN algorithm, including a presacral dissection and reinjection of tracer, results in a high SLN detection rate and identified all patients with lymph node metastases.</p>},
  author       = {Persson, Jan and Geppert, Barbara and Lönnerfors, Céline and Bollino, Michele and Måsbäck, Anna},
  issn         = {0090-8258},
  keyword      = {Anatomy,Endometrial cancer,Indocyanine green,Lymphadenectomy,Lymphatic metastases,Lymphatic system,Sentinel lymph node biopsy},
  language     = {eng},
  number       = {1},
  pages        = {120--125},
  publisher    = {Academic Press},
  series       = {Gynecologic Oncology},
  title        = {Description of a reproducible anatomically based surgical algorithm for detection of pelvic sentinel lymph nodes in endometrial cancer},
  url          = {http://dx.doi.org/10.1016/j.ygyno.2017.07.131},
  volume       = {147},
  year         = {2017},
}