Introduction The aim of this article is to demonstrate the feasibility and efficacy of florescent-image-guided pelvic lymph node dissection with radical hysterectomy in cervical cancer patients.
Description A 43-year-old woman was diagnosed with cervix cancer by punch biopsy. Pelvic MRI showed a 2.0×1.5 cm sized cervical mass and enlarged external iliac lymph node, and lymphovascular invasion with invasive squamous cell carcinoma was pathologically confirmed. The tentative FIGO stage was Cervix cancer IB. At the beginning of the operation, indocyanine green (ICG) 2cc was injected into the 3 O’clock and 9 O’clock of the cervix. After ICG injection, a single umbilicus incision was made, and pelvic lymph node dissection was performed guided by a florescent image colored by ICG. Contrary to sentinel lymph node biopsy, we selectively removed all the ICG-stained lymph nodes and lymphatic channels around the parametrium. After complete removal of lymph nodes and lymphatic channels, type C1 radical hysterectomy, paraaortic LN dissection, and left ovarian transposition were conducted. The greatest dimension of the residual tumor was 21 mm, involving a deep one-third of the stroma invasion. There was no parametrial invasion or node metastasis except diffuse lymphovascular invasion. The patient was discharged on the 6th postoperative day without any surgical complications, including lymphocele or lymphedema. Currently, there is no recurrence; progression-free interval is 76 months.
Conclusion/Implications Florescent-image-guided pelvic lymph node dissection with radical hysterectomy is the best method for pelvic lymph node dissection in terms of making it easy to operate, reducing complications associated with lymph node dissection, and reducing locoregional metastasis.
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