Johns Hopkins Medicine, Baltimore, Maryland, USA.
Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA.
Int J Gynecol Cancer. 2019 Mar;29(3):513-517. doi: 10.1136/ijgc-2019-000215.
To determine whether the rate of sentinel lymph node (SLN) dissections that do not yield a lymph node on pathological analysis ('empty packet dissection') changes with increasing surgeon experience in the setting of patients undergoing minimally invasive hysterectomy and SLN mapping using indocyanine green dye for endometrial cancer.
All patients undergoing SLN mapping using indocyanine green dye at the time of minimally invasive hysterectomy for endometrial cancer or complex atypical hyperplasia were identified between January 2013 and September 2017 at our institution. All surgeons had prior experience performing SLN mapping for endometrial cancer using other methods. The rate of empty packet dissections and SLN counts were evaluated using a logistic regression model analysis.
In total, 236 patients undergoing SLN mapping for either endometrial cancer (85%) or complex atypical hyperplasia (15%) were identified from a prospectively maintained database. When examining all six surgeons together, the percentage of empty packet dissections decreased with increasing number of procedures performed. Each additional procedure was associated with a 3.6% reduction in the odds of an empty packet SLN dissection. After adjusting for individual surgeons, each additional procedure was associated with a 4.9% reduction in the odds of an empty packet. The expected odds of an empty packet after 10 additional procedures decreased by 40.1% (95% CI 12.4% to 58.6%). The addition of two covariates (age and body mass index) did not contribute significantly to the model (likelihood ratio test: X=2.75, p=0.25). The rate of empty packets appeared to stabilize after approximately 30 procedures. The number of SLNs removed did not change with increasing surgeon experience.
The rate of empty packet SLN dissections using indocyanine green dye decreases with increasing number of procedures. This stabilizes after 30 procedures, suggesting completion of a learning curve.
确定在使用吲哚菁绿染料进行微创子宫切除术和前哨淋巴结（SLN）映射以治疗子宫内膜癌的患者中，随着外科医生经验的增加，病理分析中未发现淋巴结的 SLN 解剖（“空包解剖”）的发生率是否发生变化。
在我院，于 2013 年 1 月至 2017 年 9 月期间，确定所有接受微创子宫切除术治疗子宫内膜癌或复杂不典型增生并使用吲哚菁绿染料进行 SLN 映射的患者。所有外科医生均具有使用其他方法进行 SLN 映射治疗子宫内膜癌的先前经验。使用逻辑回归模型分析评估空包解剖术和 SLN 计数的发生率。
总共从一个前瞻性维护的数据库中确定了 236 名接受 SLN 映射治疗的患者，其中子宫内膜癌（85％）或复杂非典型增生（15％）。当同时检查六名外科医生时，空包解剖术的百分比随着手术次数的增加而降低。每增加一个手术，空包 SLN 解剖术的可能性就会降低 3.6％。在调整每位外科医生的情况后，每增加一个手术，空包的可能性就会降低 4.9％。如果进行 10 次以上的额外手术，空包的预期可能性将降低 40.1％（95％CI 12.4％至 58.6％）。添加两个协变量（年龄和体重指数）对模型没有重大贡献（似然比检验：X = 2.75，p = 0.25）。空包的发生率似乎在大约 30 次手术后趋于稳定。随着外科医生经验的增加，SLN 切除的数量没有变化。
使用吲哚菁绿染料进行空包 SLN 解剖的发生率随手术次数的增加而降低。在 30 次手术后趋于稳定，表明完成了学习曲线。
