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Evidence - pelvic lymphadenectomy on both sides, laparoscopic, robot-assisted laparoscopy (DaVinci)

gynecology
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Anatomy Perioperative management Technique Complications Evidence Total Video

  1. Indications and performance of SLNB, systematic pelvic lymphadenectomy, and para-aortic lymphadenectomy

    ProcedureIndicationExecution
    Sentinel Lymph Node Biopsy- Tumor FIGO IA1 with L1, IA2, IB1 (<2 cm).
    - No proven lymph node metastases.
    - Bilateral sentinel lymph node detection possible.    		- Identification of sentinel lymph nodes with radioactive tracer, indocyanine green, or patent blue.
    - Removal and histological examination.
    Pelvic Lymphadenectomy- Tumor >2 cm or proven lymph node metastases.
    - Inadequate sentinel lymph node detection.
    - High-risk patients (e.g., L1, deep stromal infiltration).    		- Systematic removal of obturator, iliac, and para-iliac lymph nodes.
    Para-aortic Lymphadenectomy- Proven pelvic lymph node metastases.
    - Tumor stage ≥ FIGO IIB.
    - Tumor size >4 cm with suspected lymph node involvement.    		- Removal of para-aortic lymph nodes up to the level of the renal arteries.

    Important Decision Criteria:

    • If the sentinel node is negative, systematic pelvic LNE can be omitted.
    • If no sentinel lymph node is found, systematic LNE is necessary.
    • Para-aortic lymphadenectomy only in confirmed pelvic metastases to optimize staging and therapy strategy (e.g., radiochemotherapy).

    Reference:

    1. Lecuru, F., et al., Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol, 2011. 29(13): p. 1686-91
    2. Denschlag, D., J. Woll, and A. Schneider, Importance of the Sentinel Lymph Node Concept in Uterine Carcinomas. Frauenarzt, 2011. 52(1): p. 46-51.
    3. Altgassen, C., et al., Multicenter validation study of the sentinel lymph node concept in cervical cancer: AGO Study Group. J Clin Oncol, 2008. 26(18): p. 2943-51.
    4. Ruscito, I., et al., Sentinel Node Mapping in Cervical and Endometrial Cancer: Indocyanine Green Versus Other Conventional Dyes-A Meta-Analysis. Ann Surg Oncol, 2016. 23(11): p. 3749-3756.
    5. Guideline Program Oncology (German Cancer Society, German Cancer Aid, AWMF): S3 Guideline Diagnosis, Therapy, and Follow-up of Patients with Cervical Cancer, Long Version 2.2, 2022, AWMF Register Number: 032/033OL

  2. Sentinel lymph node biopsy vs. systematic pelvic lymphadenectomy

    The sentinel technique offers lower morbidity than systematic LNE, but there is a risk of false-negative findings.

    Comparison of Procedures:

    CriterionSentinel Lymph Node Biopsy (SLNB)Systematic Pelvic LNE
    Sensitivity for Metastases91.4% (higher than PET-CT and MRI)99% (gold standard)
    Mortality & ComplicationsLower (less bleeding, lymphedema)Higher (10–20% risk of lymphedema, lymphoceles)
    Standard Procedure?Only for early stages (≤2 cm, no metastases)For all advanced stages or positive sentinel nodes
    Evidence BaseStudies show high safety in FIGO IA2/IB1Standard procedure according to S3 guideline
    • SLNB is a safe alternative to systematic LNE when both sentinel nodes are clearly depicted.
    • If sentinel nodes are not found or positive for metastases, a systematic LNE is required.

    Reference: 

    1. Selman, T.J., et al. Diagnostic accuracy of tests for lymph node status in primary cervical cancer: a systematic review and meta-analysis (Structured abstract). CMAJ: Canadian Medical Association Journal, 2008. 178, 855-862.
    2. Lecuru, F., et al., Bilateral negative sentinel nodes accurately predict absence of lymph node metastasis in early cervical cancer: results of the SENTICOL study. J Clin Oncol, 2011. 29(13): p. 1686-91
    3. Guideline Program Oncology (German Cancer Society, German Cancer Aid, AWMF): S3 Guideline Diagnosis, Therapy, and Follow-up of Patients with Cervical Cancer, Long Version 2.2, 2022, AWMF Register Number: 032/033OL
Laparoscopic vs. open lymphadenectomy

CriterionLaparoscopic LNEOpen LNE (Laparotomy)Morbidit&#xE4;tLess blood loss, fewer wound healing d

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