Santiago Domingo

Cervical injection as an alternative to the utero-ovarian ligament for mapping pelvic sentinel lymph node in early-stage ovarian cancer

Abstract Purpose In early-stage ovarian cancer, sentinel lymph node (SLN) mapping using double injection into the utero-ovarian and infundibulo-pelvic ligaments has been postulated. Cervical injection, commonly used in other gynaecologic tumors, may provide a simpler alternative to utero-ovarian injection for pelvic-SLN detection. This study aims to demonstrate whether cervical and utero-ovarian injections drain to the same pelvic SLN using different tracers for each injection site: technetium-99m (99mTc) at cervix and indocyanine green into the utero-ovarian ligament. Methods This prospective trial enrolled endometrial cancer patients scheduled for SLN biopsy from July 2023 to May 2024. Each hemipelvis was considered a case. 99mTc was injected at the cervix preoperatively. If 99mTc migration occurred, indocyanine green was injected into the utero-ovarian ligament intraoperatively. Concordance of migration was determined in those hemipelvis with both 99mTc-cervical and indocyanine green utero-ovarian migration. Results Seventeen patients (34 hemipelvis) were included. Migration from both injection sites occurred in 17 hemipelvis, identifying the same pelvic-SLN in all cases, being the concordance rate of 100%. Migration of 99mTc or indocyanine green from cervical injection was detected in 91.2% (95% CI 81.6–100%), whereas migration of indocyanine green injection from the utero-ovarian ligament was detected in 73.9% (95% CI 56–91.9%); these detection rates were not significantly different (p = 0.077). Conclusions Lymphatic migration from the cervix to the pelvis seems to be comparable to the migration from the utero-ovarian ligament to the pelvis, with both pathways converging at the same SLN.

Key issues in diagnostic accuracy of sentinel lymph node biopsy in early-stage ovarian cancer: systematic review and meta-analysis

Sentinel lymph node (SLN) mapping may reduce the morbidity of lymphadenectomy while maintaining diagnostic accuracy. Nevertheless, SLN mapping in epithelial ovarian cancer is still under investigation. This systematic review and meta-analysis aimed to assess the detection rate and diagnostic accuracy of SLN mapping for each field (pelvic and para-aortic), and to evaluate the tracers and doses used. A systematic search was conducted in PubMed, Cochrane Library, Scopus, and Web of Science. Patients with clinical stages I-II ovarian cancer undergoing SLN biopsy (index test) and a systematic pelvic and para-aortic lymphadenectomy (reference standard) were included. Risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies 2 (QUADAS-2) tool. A meta-analysis was performed to assess SLN mapping detection rates and diagnostic accuracy for each field (pelvic and para-aortic) and by subgroups (type of tracer and dosage). 239 patients from four studies were included. The SLN detection rate was 59.5% (95% CI 50.2 to 68.1%) and 64.4% (95% CI 58.2 to 70.2%) for the pelvic and para-aortic fields, respectively. The use of technetium-99 ( The use of PROSPERO CRD42024544812.

Correspondence on ‘Intrauterine manipulator use during laparoscopic hysterectomy for endometrial cancer: association for pathological factors and oncologic outcomes’ by Yoshida et al

Correspondence on “Sentinel lymph node biopsy in ovarian cancer: more questions than certainties” by Fagotti et al

Alternatives of the pelvic sentinel lymph node migration pathway in early ovarian cancer: the simplest the best

Surgical training and cervical screening in rural India hospitals

Pelvic exenteration for vulvar cancer: contemporary outcomes from a multinational cohort study

Women with vulvar cancer are considerably older than those with other gynaecological malignancies, raising concerns about the tolerability of radical surgery. Yet, for locally advanced or recurrent disease, pelvic exenteration may be the only curative option. Robust evidence to guide decision-making in this population is lacking. This multicentre observational cohort study used data from the COREPEX registry including women who underwent anterior or total pelvic exenteration between 2005 and 2023 across 20 European tertiary referral centres. The primary outcome was overall survival (OS); secondary outcomes were progression-free survival (PFS) and major postoperative complications. Associations were assessed using multivariable Cox and binomial regression models adjusted for relevant covariates. Among 861 women, 79 (9.2%) had vulvar cancer. Median follow-up was 49 months for OS and 40 months for PFS. Women with vulvar cancer were older and more often overweight. Five-year OS was 32% (95% CI, 19-46) in vulvar cancer versus 29% (95% CI, 25-34) in other cancers, adjusted HR 1.05 (95% CI, 0.75-1.46). Five-year PFS was 34% versus 29%, adjusted HR 0.96 (95% CI, 0.69-1.34). Major complications occurred in 33% vs 29%, adjusted RR 1.12 (95% CI, 0.77-1.58). Lymph node metastases, positive margins, and recurrent or persistent disease independently predicted poorer survival. Despite their older age, women with vulvar cancer had survival and morbidity comparable to those with other gynaecological malignancies. These findings support pelvic exenteration as a curative option for selected women with vulvar cancer when complete resection is feasible.

Conservative management of burst adbomen after interval cytoreduction surgery of ovarian carcinosarcoma

Laparoscopic sigmoidectomy with ghost ileostomy in ovarian cancer recurrence

Patent Blue SLN in Early Ovarian Cancer Prospective Study (FIGO I-II) Evaluating Patent Blue SLN Mapping. Injection Into IP/UO Ligaments in Situ. Goals: Assess Feasibility and Accuracy vs Standard Lymphadenectomy to Minimize Surgical Morbidity

the standard of care in case of early ovarian cancer (stage I or II) is a complete surgery. This surgery includes : hysterectomy (remove of the uterus), bilateral salpingo-oophorectomy (remove of the adnexa), omentectomy (remove of the epiploon), bilateral pelvic lymphadenectomy (remove of pelvic lymph nodes) and para-aortic lymphadenectomy (remove of para-aortic lymph nodes). This procedure is diagnostic, curative and prognostic surgery. In fact, it allows us provider care giver to stratify the stage of the cancer, hence we give the appropriate adjuvant therapy. However, this surgery, especially the extended lymphadenectomy, is associated with some risks: lymphocele, vessel injury, blood loss, morbidity, long recovery period ... In order to reduce these risks, we propose a sentinel lymph node biopsy. This intervention allows us to detect first lymph node relay whether pelvic or para-aortic. In our study, we chose the patent blue dye as a tracer. This tracer is widely used in oncologic surgery (for example in breast cancer) and approved but not in ovarian cancer yet. During surgery for early stage ovarian cancer, we will inject the patent blue dye on both side of the ovarian tumor. Then, we will check for first colorful lymph node, in both pelvic and para-aortic regions. We will send these dissected lymph node to pathology for analysis. Finally, we will continue the procedure as the standard of care. Our objective is to compare the results between the sentinel lymph node and the complete lymphadenectomy and to study the technique of sentinel lymph node biopsy using the blue patent dye as tracer.