Laparoscopic Sentinel Lymph Node Mapping Using Indocyanine Green Dye in Endometrial Cancer: Experience from a Tertiary Cancer Care Centre in South India

Objective

This study was aimed to evaluate the feasibility of laparoscopic sentinel lymph node mapping using indocyanine green (ICG) in early endometrial cancers.

Design

Prospective Cohort Study.

Setting

Tertiary care cancer centre.

Sample

Sample size of 25 patients.

Methods

Sentinel nodes which take up ICG were identified and excised. All patients underwent total laparoscopic hysterectomy with bilateral salpingo-oophorectomy and a complete pelvic and paraaortic lymph node dissection.

Outcome

A total of 25 patients were recruited. The average duration of surgery was 4.5 h, and the hospital stay was 4 days.

Results

The sentinel node detection rate was 84%. Around 56% of patients had sentinel node detection in bilateral hemipelvis. The sentinel node was detected in the paraaortic area for 44% of patients. Isolated paraaortic sentinel lymph node detected 8% patients. Metastasis was identified in 8% of cases in the final histopathology in the sentinel node. No metastasis was detected in non-sentinel pelvic and paraaortic lymphadenectomy specimens.

The decision of adjuvant therapy was changed from external beam radiation therapy to chemotherapy followed by external beam radiation therapy in 4% with SLNB positivity.

After a mean follow-up of two years, none of the patients in our study had any clinic-radiological evidence of recurrence.

Conclusion

Laparoscopic staging with sentinel node biopsy using ICG dye for endometrial cancers has a high detection rate, thus identifying nodal disease which helps to decide the adjuvant treatment as well as avoid the morbidity associated with complete lymphadenectomy, with all the benefits of minimally invasive surgery.