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Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications

Geppert, Barbara LU ; Lönnerfors, Céline LU ; Bollino, Michele and Persson, Jan LU (2017) In Gynecologic Oncology
Abstract

Objective: To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. Methods: A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. Results: The bilateral detection rate of sentinel lymph nodes was 96%... (More)

Objective: To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. Methods: A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. Results: The bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33. min whereas 91. min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p = 0.0003). Conclusion: The high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.

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organization
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Contribution to journal
publication status
epub
subject
keywords
Chylous ascites, Endometrial cancer, Indocyanine green, Lymphadenectomy, Lymphatic metastases, Lymphatic system, Lymphedema, Lymphocele, Sentinel lymph node biopsy
in
Gynecologic Oncology
publisher
Academic Press
external identifiers
  • scopus:85038918221
ISSN
0090-8258
DOI
10.1016/j.ygyno.2017.12.017
language
English
LU publication?
yes
id
d3899593-a979-40fe-a651-d062327c9ff7
date added to LUP
2018-01-23 12:04:14
date last changed
2018-10-28 04:50:38
@article{d3899593-a979-40fe-a651-d062327c9ff7,
  abstract     = {<p>Objective: To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former. Methods: A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated. Results: The bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33. min whereas 91. min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p = 0.0003). Conclusion: The high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.</p>},
  author       = {Geppert, Barbara and Lönnerfors, Céline and Bollino, Michele and Persson, Jan},
  issn         = {0090-8258},
  keyword      = {Chylous ascites,Endometrial cancer,Indocyanine green,Lymphadenectomy,Lymphatic metastases,Lymphatic system,Lymphedema,Lymphocele,Sentinel lymph node biopsy},
  language     = {eng},
  publisher    = {Academic Press},
  series       = {Gynecologic Oncology},
  title        = {Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications},
  url          = {http://dx.doi.org/10.1016/j.ygyno.2017.12.017},
  year         = {2017},
}