Does sentinel node biopsy improve the management of endometrial cancer? Data from 43 patients.

OBJECTIVES: To map sentinel lymph nodes (SLNs) detected by intracervical injection in patients with endometrial cancer and to determine the prevalence of node micrometastases. METHODS: Radionuclide and blue dye injections were used for SLN detection in 43 patients with clinical stage I endometrial cancer. Lymphoscintigraphy was done before surgery. Intraoperatively, the pelvic and para-aortic territories were examined for blue and/or radioactive nodes. Pelvic lymphadenectomy was performed with or without para-aortic lymphadenectomy. SLNs stained with hematoxylin-eosin-saffron were examined and, when negative, evaluated using step sectioning and immunohistochemistry. RESULTS: Feasibility was 100%. No adverse effects occurred. SLNs were identified in 30 patients (69.8%), usually in an interiliac location (28/30 patients, 93.3%). SLNs were found only in the common iliac chain in 1 (3%) patient and in both the common iliac chain and promontory area in another (3%). No patients had para-aortic SLNs or SLNs confined to the promontory. Node metastases were identified in eight patients and were confined to SLNs in six. In 2 (2/30, 6%) patients, SLNs contained micrometastases. No false-negatives occurred. CONCLUSIONS: Intracervical injection of radionuclide and blue dye chiefly revealed pelvic SLNs. The prevalence of micrometastases was within the expected range. Comparisons with peritumoral injection are needed.

[Comparison of different approaches in surgical management of early endometrial cancer]. / Comparaison de la coelioscopie à la laparotomie dans la prise en charge du cancer de l'endomètre précoce.

The objective is to assess the feasibility of laparoscopy in the treatment of endometrial carcinoma and to compare operating data and morbidity to laparotomy. Retrospective review of 70 consecutive patients with supposed early endometrial cancer managed between December 2000 and December 2005. Two groups were defined, whether they had been operated by laparoscopy (N = 44 ; LPS group) or by laparotomy (N = 21 ; LPM group). Both groups were comparable in mean age and body mass index. There was no significant difference in median operating time for LPS group (240 minutes [90-390]) and LPM group (195 minutes [120-600]), (p = 0.234). Intraoperative complications occurred in 2 LPS patients (4.7 %) and in 2 LPM cases (9.5 %). Women who underwent laparoscopy had more pelvic lymph nodes removed (11.5 [2-33] versus 7.5 [3-37], p < 0.05). There were comparable early and late postoperative complications in patients managed by laparoscopy (5 and 0 cases ; 27.8 and 0 %) and by laparotomy (5 and 2 cases ; 11.6 and 4.5 %), (p = 0.143 and p > 0.999). Hospital stay was longer in LPM group (9.5 days [6-39] versus 5.0 (4-27), p < 0.05). Patients who undergo laparoscopy have more pelvic lymph nodes removed, with comparable operating time, shorter hospital stay, and similar morbidity. Laparoscopic staging combined with vaginal hysterectomy appears to be a feasible alternative to conventional surgical approach in patients with endometrial carcinoma.

Sentinel lymph node biopsy improves staging in early cervical cancer.

OBJECTIVES: The main study objective was to describe the distribution of sentinel lymph nodes (SLNs) and the prevalence of SLN micrometastases in patients with early cervical cancer. The secondary objective was to confirm the SLN detection rate and negative predictive value found in our preliminary study. PATIENTS AND METHODS: We prospectively included 25 patients with early cervical cancer, each of whom received an injection of 120 MBq of technetium-99m for preoperative lymphoscintigraphy and intraoperative node detection using an endoscopic gamma probe. Patent blue dye was injected intraoperatively. SLNs were sought in the pelvic and para-aortic drainage areas. Radical iliac dissection was performed routinely at the end of the procedure. SLNs were examined after hematoxylin-eosin-saffron staining; negative specimens were assessed using immunohistochemistry. RESULTS: Most (85%) of the SLNs were in the inter-iliac territory. Para-aortic or parametrial SLNs were found respectively in 2 patients and common iliac SLNs in 5 patients. Thus 9/25 patients had additional information due to SLN detection. One metastasis and one micrometastasis were detected in SLNs. No patients had positive non-sentinel nodes with negative SLNs. CONCLUSION: SLN detection ensures the identification of SLNs in unusual locations in 36% of patients. SLN disease was found in 8% of our patients. Thus, SLN biopsy improves staging in patients with early cervical cancer. Studies in larger patient populations are needed to evaluate the clinical impact of SLN biopsy.

[Impact of surgical access on staging of early borderline and invasive tumors of the ovary]. / Effet de la voie d'abord sur la stadification chirurgicale des lésions ovariennes frontières et des cancers à un stade précoce.

The objectives were to evaluate the impact of the surgical approach on the staging of borderline tumors and early-stage malignancies of the ovary. We retrospectively reviewed cases of borderline and invasive ovarian tumors stages Ia through Ic treated surgically between January 1, 1985 and December 31, 2001. We compared the rates of potentially harmful procedures according to the surgical approach. The quality of surgical staging was assessed by examining each required procedure and by determining a score. The influence of variables related to patient characteristics, preoperative workup, and initial surgery on staging quality was tested by univariate analysis. Variables independently associated with staging quality were entered in a logistic regression model. SPPS 7.5 and STATA 8 software was used for statistical tests. Of 118 patients with borderline tumors, 48 (41 %) underwent laparoscopic surgery, 54 (45 %) laparotomy, and 16 (14 %) laparoscopy converted to laparotomy. Surgery was conservative in 57 % of cases overall ; this proportion was significantly greater with laparoscopy than with laparotomy (p < 0.05) and in younger women (p < 0.001). Intraoperative tumor rupture occurred in 9 % of patients, with no significant difference across surgical approaches (p = 0.1). Bag extraction was used in 19 (40 %) of 48 laparoscopically treated patients. Staging was incomplete in 73 % of patients. By univariate analysis, bilateral adnexectomy and, to a lesser extent, age > 44 years, laparotomy, hysterectomy, and treatment after 1995 predicted at least partial staging. Factors independently associated with at least partial staging in the multivariate model were treatment after 1995, bilateral adnexectomy, and hysterectomy. Of 178 patients with invasive tumors, 34 underwent laparoscopic surgery, 114 laparotomy, and 30 conversion from laparoscopy to laparotomy. The laparotomy group was characterized by significantly older patient age and larger tumors, compared to the laparoscopy group. Staging was often inadequate after initial surgery, most notably with low rates of paraaortic lymphadenectomy (0 % in the laparoscopy group, 18 % in the laparotomy group, and 33 % in the conversion group). Staging is often less complete with laparoscopy than with laparotomy. In patients with invasive cancer, inadequate initial staging is common, most notably when laparoscopy is used. The surgeons training seems of major importance.