TY - JOUR
T1 - Consensus on surgical technique for sentinel lymph node dissection in cervical cancer
AU - Bizzarri, Nicolò
AU - Obermair, Andreas
AU - Hsu, Heng Cheng
AU - Chacon, Enrique
AU - Collins, Anna
AU - Tsibulak, Irina
AU - Mutombo, Alex
AU - Abu-Rustum, Nadeem R.
AU - Balaya, Vincent
AU - Buda, Alessandro
AU - Cibula, David
AU - Covens, Allan
AU - Fanfani, Francesco
AU - Ferron, Gwenaël
AU - Frumovitz, Michael
AU - Guani, Benedetta
AU - Kocian, Roman
AU - Kohler, Christhardt
AU - Leblanc, Eric
AU - Lecuru, Fabrice
AU - Leitao, Mario M.
AU - Mathevet, Patrice
AU - Mueller, Michael D.
AU - Papadia, Andrea
AU - Pareja, Rene
AU - Plante, Marie
AU - Querleu, Denis
AU - Scambia, Giovanni
AU - Tanner, Edward
AU - Zapardiel, Ignacio
AU - Garcia, Jaime R.
AU - Ramirez, Pedro T.
N1 - Publisher Copyright:
© IGCS and ESGO 2024.
PY - 2024/2/20
Y1 - 2024/2/20
N2 - 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 reinjection 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.
AB - 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 reinjection 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.
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U2 - 10.1136/ijgc-2023-005151
DO - 10.1136/ijgc-2023-005151
M3 - Article
C2 - 38378695
AN - SCOPUS:85186223157
SN - 1048-891X
VL - 34
SP - 504
EP - 509
JO - International Journal of Gynecological Cancer
JF - International Journal of Gynecological Cancer
IS - 4
ER -