Consensus on surgical technique for sentinel lymph node dissection in cervical cancer Journal Article
| Authors: | Bizzarri, N.; Obermair, A.; Hsu, H. C.; Chacon, E.; Collins, A.; Tsibulak, I.; Mutombo, A.; Abu-Rustum, N. R.; Balaya, V.; Buda, A.; Cibula, D.; Covens, A.; Fanfani, F.; Ferron, G.; Frumovitz, M.; Guani, B.; Kocian, R.; Kohler, C.; Leblanc, E.; Lecuru, F.; Leitao, M. M.; Mathevet, P.; Mueller, M. D.; Papadia, A.; Pareja, R.; Plante, M.; Querleu, D.; Scambia, G.; Tanner, E.; Zapardiel, I.; Garcia, J. R.; Ramirez, P. T. |
| Article Title: | Consensus on surgical technique for sentinel lymph node dissection in cervical cancer |
| Abstract: | Objective The purpose of this study was to establish a consensus on the surgical technique for sentinel lymph node (SLN) dissection in cervical cancer. Methods A 26 question survey was emailed to international expert gynecological oncology surgeons. A two-step modified Delphi method was used to establish consensus. After a first round of online survey, the questions were amended and a second round, along with semistructured interviews was performed. Consensus was defined using a 70% cut-off for agreement. Results Twenty-five of 38 (65.8%) experts responded to the first and second rounds of the online survey. Agreement ≥70% was reached for 13 (50.0%) questions in the first round and for 15 (57.7%) in the final round. Consensus agreement identified 15 recommended, three optional, and five not recommended steps. Experts agreed on the following recommended procedures: use of indocyanine green as a tracer; superficial (with or without deep) injection at 3 and 9 o’clock; injection at the margins of uninvolved mucosa avoiding vaginal fornices; grasping the cervix with forceps only in part of the cervix is free of tumor; use of a minimally invasive approach for SLN biopsy in the case of simple trachelectomy/conization; identification of the ureter, obliterated umbilical artery, and external iliac vessels before SLN excision; commencing the dissection at the level of the uterine artery and continuing laterally; and completing dissection in one hemi-pelvis before proceeding to the contralateral side. Consensus was also reached in recommending against injection at 6 and 12 o’clock, and injection directly into the tumor in cases of the tumor completely replacing the cervix; against removal of nodes through port without protective maneuvers; absence of an ultrastaging protocol; and against modifying tracer concentration at the time of reinjection after mapping failure. Conclusion Recommended, optional, and not recommended steps of SLN dissection in cervical cancer have been identified based on consensus among international experts. These represent a surgical guide that may be used by surgeons in clinical trials and for quality assurance in routine practice. © IGCS and ESGO 2024. |
| Keywords: | adult; clinical article; human tissue; excision; surgical technique; lymph node metastasis; lymph node dissection; lymph nodes; lymphatic metastasis; lymph node excision; sentinel lymph node biopsy; clinical practice; consensus; pathology; dissection; information retrieval; questionnaire; injection; peer review; uterine cervix cancer; lymph node; medline; delphi study; tracer; uterine cervical neoplasms; uterine cervix tumor; semi structured interview; surgical margin; uterine cervix conization; iliac artery; procedures; uterine artery; indocyanine green; sentinel lymph node metastasis; humans; human; female; article; gynecologic oncologist; cervicotomy |
| Journal Title: | International Journal of Gynecological Cancer |
| Volume: | 34 |
| Issue: | 4 |
| ISSN: | 1048-891X |
| Publisher: | Lippincott Williams & Wilkins |
| Date Published: | 2024-04-01 |
| Start Page: | 504 |
| End Page: | 509 |
| Language: | English |
| DOI: | 10.1136/ijgc-2023-005151 |
| PUBMED: | 38378695 |
| PROVIDER: | scopus |
| PMCID: | PMC11825065 |
| DOI/URL: | |
| Notes: | The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF -- Source: Scopus |
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