Introduction/Background Sentinel lymph node (SLND) technique identifies the first node(s) draining any organ and uses ultra-staging to detect micro-metastases. SLND reduces surgical-related morbidity, lymphedema, lymphocyst formation and operative time.
Methodology Women requiring lymphadenectomy in endometrial cancer and cervical cancer at Guys and St Thomas Hospital (GSTT) were included. Data was collected prospectively and results were analyzed. Intra-cervical Indo Cyanine Green (ICG) was injected at two sites and surgery performed using Xi Davinci robot. Sentinel lymph node (SLN) were mapped using firefly fluorescent camera and sampled. Bilateral[A1] pelvic lymphadenectomy (BPLND) was performed in all patients after SLN sampling and para-aortic sampling for a select few. Patient demographic variables, sentinel lymph node positivity, diagnostic accuracy, negative predictive value, site of sentinel lymph node and complications were noted.
Results 52 patients underwent SLND as a part of robotic staging for gynecological malignancies (cervix and endometrium). Mean age was 65.5 years (56–82), ASA score=2 and mean BMI=31.8. A total hysterectomy and salpingo-ophorectomy was performed in addition to adhesiolysis, omental sampling and para-aortic sampling. The FIGO stages included stage-I (76) and Stage-III (18%). Median lymph node count in SLN was 3 (1–5) and BPLND was 15 (5–38). Nodal metastasis was found in positivity was 13.4% with the external iilac being most common sentinel nodal site. Para-aortic lymph node positivity was 3.84%. Diagnostic accuracy of SLND: Sensitivity 85.7%, specificity 100%, positive predictive value 100%, negative predictive value 97.83%. Complication rate was 1.1%.
Conclusion This pilot study validates the performance of sentinel lymph node sampling as accurate, comparable to international standards and mandates a change in institutional practice. SLND shall be the standard for nodal assessment in surgical staging for cancers at GSTT in the future.
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