Kimmig Rainer, Buderath Paul, Rusch Peter, Mach Pawel, Aktas Bahriye
Department of Gynecology and Obstetrics, West German Cancer Center, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
J Gynecol Oncol. 2017 Sep;28(5):e68. doi: 10.3802/jgo.2017.28.e68. Epub 2017 Jun 13.
Para-aortic indocyanine-green (ICG)-guided targeted compartmental lymphadenectomy is feasible in early ovarian cancer; systematic pelvic and para-aortic lymphadenectomy could potentially be avoided if thoroughly investigated sentinel nodes could predict whether residual nodes will be involved or free of disease. In contrast to advanced ovarian cancer, where the therapeutic potential of lymphadenectomy will soon be clarified by the results of the Arbeitsgemeinschaft Gynäkologische Onkologie lymphadenectomy in ovarian neoplasms (AGO LION) trial, systematic lymphadenectomy seems to be mandatory for diagnostic and also therapeutic purposes in early ovarian cancer. Sentinel node biopsy or resection of the regional lymphatic network may reduce morbidity compared to systematic lymphadenectomy as shown already for other entities. Apart from the ovarian mesonephric pathway, a second Müllerian uterine pathway exists for lymphatic drainage of the ovary. Lymphatic valves apparently do not exist at this level of the utero-ovarian network since injection of radioactivity into the ovarian ligaments also labelled pelvic nodes.
We applied ICG using 4×0.5 mL of a 1.66 mg/mL ICG solution for transcervical injection into the fundal and midcorporal myometrium at each side [10] instead of injection into the infundibulopelvic ligament, since the utero-ovarian drainage was intact.
In this case a 1.8 cm cancer of the right ovary was removed in continuity with its draining lymphatic vessels and at least the first 2 sentinel nodes in each channel "en bloc" as shown in this video for the pelvic part, consistent with the loco-regional ontogenetic approach.
This could potentially avoid most of systematic lymphadenectomies in early ovarian cancer.
在早期卵巢癌中，腹主动脉旁吲哚菁绿（ICG）引导下的靶向分区淋巴结切除术是可行的；如果对前哨淋巴结进行充分研究能够预测残留淋巴结是否会受累或无疾病，那么系统性盆腔和腹主动脉旁淋巴结切除术可能可以避免。与晚期卵巢癌不同，在晚期卵巢癌中， Arbeitsgemeinschaft Gynäkologische Onkologie卵巢肿瘤淋巴结切除术（AGO LION）试验的结果很快将阐明淋巴结切除术的治疗潜力，而在早期卵巢癌中，系统性淋巴结切除术似乎对于诊断和治疗目的都是必要的。如已在其他实体瘤中所示，与系统性淋巴结切除术相比，前哨淋巴结活检或区域淋巴网络切除可能会降低发病率。除了卵巢中肾途径外，卵巢还存在第二条苗勒管子宫途径用于淋巴引流。由于将放射性物质注入卵巢韧带也标记了盆腔淋巴结，子宫 - 卵巢网络的这一水平显然不存在淋巴管瓣膜。
我们使用4×0.5 mL 1.66 mg/mL的ICG溶液经宫颈注射到子宫底部和体部肌层的两侧[10]，而不是注入漏斗骨盆韧带，因为子宫 - 卵巢引流是完整的。
在这个病例中，如本视频中盆腔部分所示，一个1.8 cm的右侧卵巢癌与其引流淋巴管以及每个通道中至少前2个前哨淋巴结一起被整块切除，这与局部区域发育起源方法一致。
这有可能避免早期卵巢癌中的大多数系统性淋巴结切除术。
