INTRA- AND EARLY POSTOPERATIVE RESULTS OF BIOPSY OF SIGNAL LYMPH NODE UNDER CONTROL OF ICG MAPPING IN PATIENTS WITH ENDOMETRIAL CANCER OF INITIAL STAGES

Abstract

Biopsy of sentinel lymph nodes (SNL) with the use of indocyanine green (ICG) as an indicator is becoming a standard method for evaluating the lymphatic reservoir in endometrial cancer in patients in the early stages.
 The purpose of the study. To conduct a comparative assessment of іntra- and early postoperative results in patients with endometrial cancer of initial stages when performing systemic lymphadenectomy and ICG mapping for the detection of SLNs.
 Materials and methods. The study included 98 patients (2017-2022) with morphologically verified endometrial cancer with low and mediumintermediate risks of metastasis. Removal of lymph nodes was carried out in two ways: 1)systemic lymphadenectomy (group 1); 2) ICG mapping for detection of SLN in the pelvic area (group 2).
 Results. The time of the operation for 1 group is longer - (63.7 ± 14.8) min. than for the second - (36.4 ± 8.9) min. In group 1, intraoperative lesions of the obturator nerve were detected in 2 patients (4.5%), postoperative complications also were observed: lymphocysts 3 (7.5%), lymphostasis 2 (5.5%), prolonged lymphorrhea 4 (9.5%) and. There were no complications in group 2. In both groups, there were no bleedings and intraoperative injuries of the pelvic organs. In group 1, the average number of extracted LVs was 8.5±2 on each side; positive LNs were found in 3 (8%) patients, the remaining 38 (92%) were negative. Identification of the localization of LN was not carried out; since their evacuation from the abdominal cavity was carried out in a single block - 32 (80%), in 8 (20%) - fragmentary (which still does not allow identification of the position of the LN). No metastases were detected in group 2; in 40 (70 %) patients, SLN was detected on both sides, 11 (20 %) - on one side, and 6 (10 %) - not detected. In these 10% of patients, systemic lymph node dissection was performed. The most common localizations of LN are the external iliac vessels and the obturator area on both sides.
 Conclusions. SLN biopsy should be used more often in early-stage endometrial cancer. The SLN technique can be used in patients with low and intermediate risk of lymphatic metastases to reduce the frequency of complications associated with systemic lymph node dissection. This technique can be used for patients with a higher risk of metastasis (in particular, average and high-average) in the presence of concomitant comorbid pathology. Its advantages are: reducing the trauma of the procedure, surgical comorbidity (lymphorrhea, lymphocysts, vascular and nerve injury), reducing the time of surgical intervention (which reduces the risk of infectious complications), reduction of blood loss, shortening of hospitalization, faster recovery, improvement of cosmetic effect and equivalence of oncological results.