Introduction/Background Sentinel lymph node (SLN) mapping with indocyanine green (ICG) is emerging as a feasible alternative to pelvic lymphadenectomy in endometrial cancer staging. Although ICG SLN mapping is well established in robo-laparoscopic surgery, there is little literature validating its use in laparotomy.
Methodology The technique, effectiveness and feasibility of SLN mapping with ICG during laparotomy for endometrial cancer is discussed. For each patient, intra-cervical ICG injection at the 3 and 9 o’clock positions was performed. Following peritoneal dissection, lymph node chains were inspected in near infrared mode using the Karl Storz Vitom(R) camera system. In each hemi-pelvis, if SLN mapping was not achieved, ipsilateral pelvic lymphadenectomy was performed. Full pelvic lymphadenectomy was also performed if there were suspicious nodes, large tumour size or extensive myometrial invasion.
Results Between March 2016 and February 2019, 37 patients with endometrial cancer underwent laparotomy. Average operating time was 133 minutes Median blood loss was 200 mls. There were no complications related to the use of ICG dye. The detection rate of SLNs was 92%. Bilateral pelvic SLNs mapping was achieved in 81% of patients, whereas 11% of patients had mapping to unilateral pelvic nodes. The median number of SLNs was 3. SLNs were mapped most commonly to the external iliac nodes, followed by the obturator and internal iliac nodes. In 3 patients (8.1%), SLNs were positive for metastases, resulting in a higher surgical stage and influencing the decision for adjuvant therapy. One patient also had mapping to a para-aortic node, which was positive for metastasis. Full pelvic lymphadenectomy was performed in 17 patients (46%). The sensitivity of SLN mapping in these patients was 100%, with no falsely negative SLNs.
Conclusion SLN mapping with ICG is accurate and feasible in patients with endometrial cancer requiring laparotomy, and has a high detection rate and sensitivity comparable to that of robo-laparoscopic surgery.
Disclosure Nothing to disclose.
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