Transperitoneal vs extraperitoneal approach for aortic sentinel node detection in endometrial cancer

Area of Science:

• Gynecologic Oncology
• Surgical Oncology
• Nuclear Medicine

Background:

• Sentinel lymph node (SLN) biopsy is increasingly used for lymph node staging in endometrial cancer, potentially replacing traditional lymphadenectomy.
• Standardization of SLN detection techniques, particularly for aortic lymph nodes, remains an area of active research.

Purpose of the Study:

• To evaluate the detection rates and anatomical locations of aortic SLNs following dual cervical and fundal indocyanine green injection in endometrial cancer patients.
• To compare the efficacy of transperitoneal versus extraperitoneal surgical approaches for aortic SLN detection.

Main Methods:

• A retrospective analysis of 278 patients with endometrial cancer who underwent laparoscopic surgery and SLN biopsy with dual indocyanine green injection.
• Post hoc comparison of transperitoneal and extraperitoneal approaches for aortic SLN identification, with backup lymphadenectomy in high-risk cases.

Main Results:

• Overall SLN detection rate was 93.2%, with pelvic detection at 90.3%.
• Aortic SLN detection rate was 66.9%, with similar rates between transperitoneal (65.0%) and extraperitoneal (69.6%) approaches (P=.441).
• The surgical approach influenced the laterality of aortic SLN detection (P=.002), but not its location relative to the inferior mesenteric artery.

Conclusions:

• Both transperitoneal and extraperitoneal approaches achieve comparable aortic SLN detection rates in endometrial cancer.
• The surgical approach impacts the specific locations of detected aortic SLNs but does not affect overall pelvic SLN detection.
• These findings support the utility of SLN biopsy for staging aortic lymph nodes in endometrial cancer using either surgical approach.