Prospective trial of hysteroscopic sentinel mapping in stage I endometrial cancer

  • Becker S
  • Fehm T
  • Rothmund R
 et al. 
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Abstract

Introduction: Minimally invasive and minimally traumatizing surgical techniques are being adopted in many areas of gynaecologic oncology. The laparoscopic approach to pelvic and paraaortic lymphadenectomy can easily be combined with sentinel node detection, to allow for faster and less extensive surgery. Clinical feasibility and reliability, particularly in a routine clinical setting remain to be proven. Methods: We prospectively looked at 142 patients who underwent standard laparoscopic surgery for histologically proven endometrial cancer. Surgery included total laparoscopic hysterectomy as well as pelvic lymphadenectomy and paraaortic lymphadenectomy when indicated. 71 patients underwent hysteroscopically guided peritumoral injection of technetium, followed by lymphszintigraphy prior to surgery. 72 patients served as controls. Sentinel nodes were detected and removed when possible. All patients received classic lymphadenectomy as clinically indicated. Results: 142 patients underwent total laparoscopic hysterectomy and laparoscopic lymphadenectomy. Average duration of surgery was 219 minutes in the non-sentinel and 210 minutes in the sentinel group. On average, 16,7 and 16,3 lymphnodes were detected. The rate of metastasis was 3/72 in the control group and 1/71 in the sentinel group. The sentinel lymphnode was detected in 53/71 cases (75%). Conclusions: As part of a research process that took several yeary, sentinel lymphnode techniques have become routine practise in the treatment of breast cancer and melanoma. In view of the high rate of negative lymphnodes in early stage endometrial cancer - as underlined by our study - efforts to improve existing techniques are needed. Sentinal lymphnode sampling will most likely be the only way to maintain adequate TNM-staging for endometrial cancer in the face of increasingly critical assessments of the benefits of complete lymphonodektomy.

Author-supplied keywords

  • breast cancer
  • control group
  • endometrium cancer
  • endoscopy
  • hysterectomy
  • injection
  • laparoscopic surgery
  • lymph node
  • lymph node dissection
  • melanoma
  • metastasis
  • oncology
  • patient
  • pelvis
  • pelvis lymphadenectomy
  • reliability
  • sampling
  • society
  • staging
  • surgery
  • surgical technique
  • technetium

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Authors

  • S Becker

  • T Fehm

  • R Rothmund

  • K Gardanis

  • R Hornung

  • W Zubke

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