RESUMEN
BACKGROUND: Since October 2018, lymph node status has become part of the FIGO staging, given that it is one of the most important prognostic factors among women with CC. The aim was to determine the rate of atypical lymphatic drainage in patients with clinical early-stage cervical cancer using a hybrid tracer (ICG-99mTc nanocolloid). METHODOLOGY: A prospective, observational, single-centre study conducted at Son Espases University Hospital between January 2019 and October 2023. Patients with clinical early-stage CC who underwent SLN mapping were included. External iliac and obturator nodes were defined as common locations. Para-aortic, common iliac, presacral, internal iliac, and parametrial nodes were defined as atypical locations. RESULTS: Thirty-nine cases of CC were included. The overall SLN detection rate was 97.4%, with 89.5% bilaterally. Positive nodes were found in 21.1% of patients. Atypical lymphatic drainage was present in 8 out of 38 (21.1%) patients. Of all the SLNs biopsied (146), 10.3% corresponded to an atypical zone. SLN in the atypical area had a higher proportion of metastasis than the usual area (37.5% vs. 16.7%; p = 0.327). CONCLUSIONS: SLN biopsy can detect unusual drainage in a significant proportion of patients. Atypical lymph nodes have a higher percentage of metastasis, which consequently improves staging and tailoring therapy. SLN mapping performed via a standardized surgical technique using a hybrid tracer (ICG-99mTc) could help in the identification of the "true SLN".
RESUMEN
Objetivo: Evaluación retrospectiva de la factibilidad, la morbilidad perioperatoria y supervivencia a medio plazo de la histerectomía radical laparoscópica total en el cáncer de cérvix. Material y métodos: El estudio incluye 31 casos consecutivos de cáncer de cérvix en estadio clínico IA2 (n = 4), IB1 (n = 21), IIA (n = 2) y IB2 (n = 3) programados para histerectomía radical laparoscópica total. Se analizan las características histológicas de los tumores, la evolución de la técnica quirúrgica, las variables perioperatorias, las complicaciones postoperatorias y los resultados de supervivencia a medio plazo. Resultados: La tasa de factibilidad fue del 96%. La complicación operatoria más frecuente fue la cistotomía accidental (3 casos). La tasa de complicaciones postoperatorias fue del 20% (6 casos), incluido 1 caso de reintervención quirúrgica. El tiempo operatorio medio fue de 258 min (rango: 180-360). La tasa de transfusión sanguínea fue del 17% (5 casos) y la estancia hospitalaria fue de 7,8 días (rango: 2-29). Al mes de la intervención el 72% de las pacientes habían normalizado la función miccional. El tamaño tumoral medio fue de 26,5 mm y la tasa de ganglios pélvicos positivos fue del 17% (n = 5). El tiempo medio de seguimiento fue de 26 meses. La tasa de recidivas fue del 17% (n = 5) y la supervivencia libre de enfermedad fue del 100% para los estadios IB2, el 82,6% para los estadios IB1/IIA y 66,7% para los estadios IB2. Conclusiones: La histerectomía radical laparoscópica total es una técnica factible en la mayoría de los pacientes con cáncer de cérvix, requiere más tiempo operatorio que la vía abdominal, pero presenta menor morbilidad perioperatoria, menor necesidad de transfusiones y menor estancia hospitalaria. La supervivencia a medio plazo es equiparable a la vía abdominal convencional
Objective: To assess feasibility, perioperative morbidity and medium term survival of total laparoscopic radical hysterectomy in cervical cancer. Material and methods: A total of 31 consecutive patients diagnosed FIGO clinical stage IA2 (n = 4), IB1 (n = 22), IIA (n = 2) and IB2 (n = 3) in Son Llàtzer hospital (Palma de Mallorca) that were programmed for a total laparoscopic radical hysterectomy were studied. We analyzed tumor histological characteristics, surgical technique, perioperative variables, postoperative complications and mid-term survival results. Results: Feasibility rate was 96%. The most frequently operative complication was accidental bladder incision (3 cases). Postoperative complications rate was 20% (6 cases) which includes one surgical reintervention. Average operative time was 258 minutes (range: 180-360). Blood transfusion rate was 17% (n = 5) and mean hospital stay was 7.8 days (range: 2-29). After one month after surgery 72% of patients had a normal miccional function. Mean tumoral size was 26.5 mm and lymphatic positive nodes rate was 17% (n = 5). Mean follow-up time was 26 months. Tumor relapse rate was 17% (n = 5) and survival-free disease of 100% for IA2 stage, 82.6% of IB1/IIA stages and 66.7% for IB2 stage. Conclusions: Total laparoscopic radical hysterectomy is a feasible technique in most of the patients with cervical cancer. It needs more operative time than abdominal route but it presents less perioperative morbidity, less blood transfusion and less hospitalization days. The medium term survival is comparable with conventional abdominal route