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Abstract
Introduction/Background One of the unanswered clinical questions in the treatment of the early stage cervical cancer is the surgical approach of sentinel lymph node (SLN). Our proposal is performing a laparoscopic SLN biopsy with a frozen section of the SLN as the first step in the procedure. If lymph nodes are negative for malignancy intraoperative, an open radical hysterectomy can be continue. If lymph nodes are positive for malignancy, the radical hysterectomy is avoided and a paraaortic staging should be performed. In this last scenario, the open surgery is not performed after the laparoscopy, sparing the patient a futile laparotomy.
Methodology Patients were eligible if they had any histological type of invasive carcinoma of the cervix on final pathology with a clinical-stage IA1 to IB2 according to the staging system of the FIGO 2018, no extrauterine disease detected by an imaging test, and a laparoscopic SLN performed. Patients with pelvic or abdominal previous radiotherapy, extrauterine disease, or laparotomic SLN approach were excluded.Patients were categorized a priori into two groups based on the surgical approach of the radical hysterectomy (laparoscopy vs laparotomy).
Results A total of 88 patients with early-stage cervical cancer between January 2010 and July 2021 were evaluated. Sixty-two patients met the inclusion criteria . Fifty-two patients (84%) had a negative intraoperative SLN performed by laparoscopy: 40 patients who underwent laparoscopic radical hysterectomy vs. 12 with open radical hysterectomy. Ten patients (16%) had a positive intraoperative SLN and the radical hysterectomy was discarded, paraaortic lymphadenectomy was performed and the patients were referred to definitive treatment with chemoradiation.
Conclusion Laparoscopic SLN biopsy with an intraoperative analysis before open radical hysterectomy spare a 16% of futile laparotomies.