Sentinel Navigation Surgery for Local Advanced Cervical Cancer

Cervical cancer is the fourth most frequent cancer in women and the fourth leading cause of cancer related deaths in females. Primary surgical treatment, including radical hysterectomy and pelvic lymph node dissection (PLND), is considered the standard of care. However, lymphedema has been observed in 35% of patients who undergo surgery, including lymphadenectomy for cervical cancer. The sentinel lymph nodes (SLN) are the first lymph nodes to receive drainage from their tumor. An SLN biopsy for patients with cervical cancer was first reported in 1995. SLN biopsy appears to be feasible for detecting lymph node metastasis in patients with early-stage cervical cancer. The SLN biopsy can reduce surgical morbidities such as intraoperative blood loss and lower the risk of postoperative complications of lymphedema and lymphocyst for the patients with radical hysterectomy of cervical cancer. Recently, several reports have shown that indocyanine green (ICG) has a feasible detection rate in patients with uterine cervical cancer. Several studies suggest that SLN biopsy without a systematic lymphadenectomy is a safe treatment modality for early-stage cervical cancer and a tumor size ≤2 cm, and there was no significant difference between SLN biopsy and lymphadenectomy in the oncologic outcomes for the patients with cervical cancer. However, SLN biopsy and/or SLN mapping for the patients with cervical cancer has not been yet covered by public health insurance at the present time in Japan, and only 22% facilities have experience in SLN biopsy for gynecological cancers in Japan.