Consensus on surgical technique for sentinel lymph node dissection in cervical cancer

被引：16

作者：

Bizzarri, Nicolo ^{[1
,31
]}

Obermair, Andreas ^{[2
]}

Hsu, Heng-Cheng ^{[3
]}

Chacon, Enrique ^{[4
]}

Collins, Anna ^{[5
]}

Tsibulak, Irina ^{[6
]}

Mutombo, Alex ^{[7
]}

Abu-Rustum, Nadeem R. ^{[8
]}

Balaya, Vincent ^{[9
]}

Buda, Alessandro ^{[10
]}

Cibula, David ^{[11
]}

Covens, Allan ^{[12
]}

Fanfani, Francesco ^{[1
]}

Ferron, Gwenael ^{[13
]}

Frumovitz, Michael ^{[14
]}

Guani, Benedetta ^{[15
]}

Kocian, Roman ^{[11
]}

Kohler, Christhardt ^{[16
,17
]}

Leblanc, Eric ^{[18
]}

Lecuru, Fabrice ^{[19
]}

Leitao Jr, Mario M. ^{[8
]}

Mathevet, Patrice ^{[20
]}

Mueller, Michael D. ^{[21
]}

Papadia, Andrea ^{[22
,23
]}

Pareja, Rene ^{[24
,25
]}

Plante, Marie ^{[26
]}

Querleu, Denis ^{[1
]}

Scambia, Giovanni ^{[1
]}

Tanner, Edward ^{[27
]}

Zapardiel, Ignacio ^{[28
]}

Garcia, Jaime R. ^{[29
]}

Ramirez, Pedro T. ^{[30
]}

机构：

[1] Fdn Policlin Univ Agostino Gemelli, IRCCS, UOC Ginecol Oncolog, Dipartimento Sci Salute Donna Bambino & Sanita Pub, Rome, Italy

[2] Univ Queensland, Fac Med, Queensland Ctr Gynaecol Canc Res, Ctr Clin Res, Brisbane, Qld, Australia

[3] Natl Taiwan Univ Hosp, Hsin Chu Branch, Obstet & Gynaecol, Hsinchu, Taiwan

[4] Univ Navarra, Gynaecol Oncol, Pamplona, Spain

[5] Derby Hosp NHS Fdn Trust, Obstet & Gynaecol, Derby, England

[6] Med Univ Innsbruck, Dept Obstet & Gynaecol, Innsbruck, Austria

[7] Univ Kinshasa, Gynaecol & Obstet, Kinshasa, DEM REP CONGO

[8] Mem Sloan Kettering Canc Ctr, Dept Surg, Gynecol Serv, New York, NY USA

[9] CHU Nord Reun, Felix Guyon Hosp, Dept Obstet & Gynaecol, St Denis, France

[10] Osped Michele & Pietro Ferrero, Gynaecol Oncol, Verduno, Italy

[11] Charles Univ Prague, Fac Med 1, Dept Obstet & Gynecol, Prague, Czech Republic

[12] Toronto Sunnybrook Reg Canc Ctr, Gynecol Oncol, Toronto, ON, Canada

[13] Inst Univ Canc Toulouse Oncopole, Dept Surg Oncol, Inst Claudius Regaud, Toulouse, France

[14] Univ Texas MD Anderson Canc Ctr, Dept Gynecol Oncol & Reprod Med, Houston, TX USA

[15] Fribourg Hosp, Dept Obstet & Gynaecol, Fribourg, Switzerland

[16] Univ Cologne, Dept Gynaecol, Cologne, Germany

[17] Asklepios Hosp Grp, Dept Special Operat & Oncol Gynaecol, Asklepios Clin Hamburg Altona, Hamburg, Germany

[18] Ctr Oscar Lambret, Dept Surg Oncol, Lille, France

[19] Inst Curie, Breast Gynecol & Reconstruct Surg Unit, Paris, France

[20] CHU Vaudois, Dept Gynecol Obstet & Genet Med, Lausanne, Switzerland

[21] Univ Hosp Berne, Gynaecol & Gynaecol Oncol, Dept Gynaecol, Inselspital, Bern, Switzerland

[22] Osped Cantonale, Dept Gynaecol & Obstet, Lugano, Switzerland

[23] Univ Svizzera Italiana, Lugano, Switzerland

[24] Clin Astorga, Dept Gynaecol Gynaecol Oncol, Medellin, Colombia

[25] Inst Nacl Cancerol, Bogota, Colombia

[26] Laval Univ, Quebec City, PQ, Canada

[27] Northwestern Univ, Dept Obstet & Gynecol, Evanston, IL USA

[28] La Paz Univ Hosp, Gynecol Oncol Unit, Madrid, Spain

[29] Univ Texas MD Anderson Canc Ctr, Dept Acad Analyt & Technol, Houston, TX USA

[30] Houston Methodist Hosp, Dept Obstet & Gynecol, Houston, TX USA

[31] Fdn Policlin Univ A Gemelli IRCCS, Dipartimento Sci Salute Donna Bambino & Sanita Pub, Ginecol Oncol, I-00168 Rome, Italy

来源：

INTERNATIONAL JOURNAL OF GYNECOLOGICAL CANCER | 2024年 / 34卷 / 04期

基金：

美国国家卫生研究院;

关键词：

Cervical Cancer; Sentinel Lymph Node; Laparoscopes; ENDOMETRIAL CANCER; MULTICENTER; BIOPSY; TRIAL; RISK;

D O I：

10.1136/ijgc-2023-005151

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

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 re-injection 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.

引用

页码：504 / 509

页数：6