Sentinel Lymph-Node Mapping with Near-Infrared Indocyanine Green in Laparotomy for Early Endometrial Cancer

Objective: Sentinel lymph-node (SLN) mapping with indocyanine green (ICG) and near-infrared (NIR) imaging is a feasible alternative to pelvic lymphadenectomy in endometrial cancer staging. While ICG SLN mapping is now used extensively in minimally invasive surgery, there is little literature validating its use in open surgery. The technique, and the effectiveness and feasibility of ICG SLN mapping in open surgical staging for endometrial cancer are discussed. Materials and Methods: This single-center cohort study looked at patients with early endometrial cancer undergoing staging laparotomy between March 2016 and February 2019. Intracervical ICG injection was performed prior to peritoneal dissection. Lymph-node chains were inspected in NIR mode. In each hemipelvis, if SLN mapping was not achieved, ipsilateral pelvic lymphadenectomy was performed. Full pelvic lymphadenectomy was then performed if there were suspicious nodes, large tumor sizes, or if surgeons preferred to have this done. Results: The study included 36 patients. Average operating time was 139 minutes. Median blood loss was 131 mL. ICG use did not cause any complications. The detection rate of SLNs was 92%. Bilateral pelvic SLN mapping was achieved in 81% of patients. The median number of SLNs was 3. SLNs were mapped most commonly to the external iliac (53%) and obturator (30%) nodes. In 4 patients (11%), SLNs were positive. Full pelvic lymphadenectomy was performed in 18 patients (50%). No false-negative SLNs were detected. Conclusions: SLN mapping with ICG is technically feasible in patients with endometrial cancer requiring laparotomy. SLN mapping in laparotomy has high SLN-detection rates and minimal side-effects comparable to that of minimally invasive surgery. (J GYNECOL SURG 20XX:000)