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Consensus on surgical technique for sentinel lymph node dissection in cervical cancer
N. Bizzarri, A. Obermair, HC. Hsu, E. Chacon, A. Collins, I. Tsibulak, A. Mutombo, NR. Abu-Rustum, V. Balaya, A. Buda, D. Cibula, A. Covens, F. Fanfani, G. Ferron, M. Frumovitz, B. Guani, R. Kocian, C. Kohler, E. Leblanc, F. Lecuru, MM. Leitao,...
Language English Country England, Great Britain
Document type Journal Article
NLK
ProQuest Central
from 2018-01-01 to 6 months ago
Health & Medicine (ProQuest)
from 2018-01-01 to 6 months ago
- MeSH
- Sentinel Lymph Node Biopsy methods MeSH
- Indocyanine Green MeSH
- Consensus MeSH
- Humans MeSH
- Lymph Node Excision methods MeSH
- Lymphatic Metastasis pathology MeSH
- Lymph Nodes pathology MeSH
- Uterine Cervical Neoplasms * surgery pathology MeSH
- Check Tag
- Humans MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
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.
Breast Gynaecology and Reconstructive Surgery Unit Institute Curie Paris France
Department of Gynaecology and Obstetrics Ente Ospedaliero Cantonale Lugano Switzerland
Department of Gynaecology Gynaecologic Oncology Clinica Astorga Medellin Colombia
Department of Gynaecology University of Cologne Koln Germany
Department of Obstetrics and Gynaecology Felix Guyon Hospital CHU Nord Réunion France
Department of Obstetrics and Gynaecology Fribourg Hospitals Fribourg Switzerland
Department of Obstetrics and Gynaecology Medical University of Innsbruck Innsbruck Austria
Department of Obstetrics and Gynecology Houston Methodist Hospital Houston Texas USA
Department of Obstetrics and Gynecology Northwestern University Evanston Illinois USA
Department of Surgical Oncology Centre Oscar Lambret Lille France
Gynaecologic Oncology Ospedale Michele e Pietro Ferrero Verduno Italy
Gynaecologic Oncology Universidad de Navarra Pamplona Spain
Gynaecology and Obstetrics University of Kinshasa Kinshasa Congo
Gynecologic Oncology Toronto Sunnybrook Regional Cancer Center Toronto Ontario Canada
Gynecologic Oncology Unit La Paz University Hospital Madrid Spain
Instituto Nacional de Cancerología Bogotá Colombia
Laval University Quebec City Quebec Canada
Obstetrics and Gynaecology Derby Hospitals NHS Foundation Trust Derby UK
Obstetrics and Gynaecology National Taiwan University Hospital Hsin Chu Branch Hsinchu Taiwan
References provided by Crossref.org
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