En Bloc Resection of Sentinel Lymph Nodes with the Hysterectomy Specimen in Endometrial Cancer

Manolis Nikolopoulos ¹, Vasileios Mitsopoulos ², Anni Innamaa ²

⁰Poole Hospital, University Hospitals Dorset NHS Foundation Trust, Poole, UK. manolis.nikolopoulos@nhs.net.

Annals of Surgical Oncology +

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April 13, 2024

View abstract on PubMed

Summary

This study presents a new surgical technique for removing sentinel lymph nodes with afferent lymphatic vessels during hysterectomy for endometrial cancer. This method aims to improve cancer staging and treatment planning by ensuring complete removal of potential cancer spread.

Area Of Science

Gynecologic Oncology
Surgical Innovation
Cancer Staging

Background

Sentinel lymph node biopsy is an established staging method for endometrial cancer.
Tumor cells can be present in afferent lymphatic vessels, even if sentinel nodes are negative.
Current techniques may not capture all potential sites of cancer spread.

Purpose Of The Study

To demonstrate a surgical technique for en bloc removal of sentinel lymph nodes with afferent lymphatic vessels and the uterus.
To assess the feasibility of this novel approach for enhanced endometrial cancer staging.

Main Methods

Utilized the Da Vinci Xi surgical system with Firefly infrared imaging.
Injected indocyanine green cervically to identify sentinel lymph nodes and afferent lymphatics.
Mobilized lymphovascular tissue, skeletonized and ligated the uterine artery, and performed colpotomy for specimen retrieval.

Main Results

Successfully demonstrated the technique for en bloc removal of sentinel lymph nodes with afferent lymphatic vessels.
The technique allows for the potential capture of cancer cells within the lymphatic vessels, not just the node itself.

Conclusions

This novel technique may improve endometrial cancer staging accuracy by including afferent lymphatic vessels.
It has the potential to enhance adjuvant treatment planning and improve patient outcomes.
Further studies are needed to evaluate the feasibility and sensitivity of detecting disease in afferent lymphatic vessels.