Gorostidi Mikel, Ruiz Ruben, Galan Claudia, Jaunarena Ibon, Cobas Paloma, Lekuona Arantxa, Diez-Itza Irene
Obstetrics & Gynecology department, Hospital Universitario Donostia, San Sebastin, Spain (Drs Gorostidi, Ruiz, Galan, Jaunarena, Cobas, Lekuona, and Diez-Itza).
Biodonostia Health Research Institute, San Sebastin, Spain (Drs Gorostidi, Jaunarena, Lekuona, and Diez-Itza).
AJOG Glob Rep. 2022 Oct 17;2(4):100120. doi: 10.1016/j.xagr.2022.100120. eCollection 2022 Nov.
Although the sentinel lymph node technique in endometrial cancer is currently replacing pelvic and aortic lymphadenectomy for the evaluation of lymph node status in endometrial cancer, its performance is not yet standardized.
This study aimed to describe the detection rates and locations of aortic sentinel lymph node detection after dual cervical and fundal indocyanine green injection in patients with endometrial cancer, using the transperitoneal and extraperitoneal approaches.
Between June 26, 2014 and December 31, 2019, 278 patients underwent laparoscopic surgery for endometrial cancer at our institution. In all cases, we performed sentinel lymph node biopsy with dual cervical and fundal indocyanine green injection, and back-up lymphadenectomy in high-risk cases. A post hoc analysis was performed to evaluate differences between the transperitoneal and extraperitoneal approach to aortic sentinel lymph nodes.
The detection rates were as follows: overall detection rate: 93.2% (259/278); pelvic detection rate: 90.3% (251/278); bilateral pelvic detection rate: 68.0% (189/278); aortic detection rate: 66.9% (186/278); and isolated aortic detection rate: 2.88% (8/278). Transperitoneal and extraperitoneal aortic detection rates were similar (65.0% and 69.6%, respectively), with no significant differences (=.441). Isolated aortic metastases were similar in both groups (2% vs 4.7%, respectively; =.185). The laterality of aortic sentinel lymph node detection was influenced by the surgical approach (=.002), but not its location above or below the inferior mesenteric artery (=.166 and =.556, respectively).
The detection rates at the aortic level were similar between the transperitoneal and extraperitoneal approaches, with no impact on subsequent pelvic detection. The transperitoneal approach detected more laterocaval, precaval, and interaortocaval nodes, whereas the extraperitoneal approach detected more preaortic and left lateroaortic nodes.
尽管子宫内膜癌前哨淋巴结技术目前正在取代盆腔和主动脉淋巴结清扫术来评估子宫内膜癌的淋巴结状态，但其操作尚未标准化。
本研究旨在描述采用经腹和腹膜外途径，在子宫内膜癌患者宫颈和宫底双部位注射吲哚菁绿后主动脉前哨淋巴结的检出率及位置。
2014年6月26日至2019年12月31日期间，278例患者在我院接受了子宫内膜癌腹腔镜手术。所有病例均采用宫颈和宫底双部位注射吲哚菁绿进行前哨淋巴结活检，高危病例行补救性淋巴结清扫术。进行事后分析以评估经腹和腹膜外途径对主动脉前哨淋巴结的差异。
检出率如下：总体检出率：93.2%（259/278）；盆腔检出率：90.3%（251/278）；双侧盆腔检出率：68.0%（189/278）；主动脉检出率：66.9%（186/27）；孤立主动脉检出率：2.88%（8/278）。经腹和腹膜外主动脉检出率相似（分别为65.0%和69.6%），无显著差异（P = 0.441）。两组孤立主动脉转移情况相似（分别为2%和4.7%；P = 0.185）。主动脉前哨淋巴结检出的侧别受手术途径影响（P = 0.002），但不受其在肠系膜下动脉上方或下方位置的影响（分别为P = 0.166和P = 0.556）。
经腹和腹膜外途径在主动脉水平的检出率相似，对后续盆腔检出无影响。经腹途径检出更多腔静脉外侧、腔静脉前和主动脉腔静脉间淋巴结，而腹膜外途径检出更多主动脉前和主动脉左侧淋巴结。
