Is indocyanine green (ICG) the best tracer for sentinel lymph node (SLN) mapping in early-stage cervical and endometrial cancer?

Abstract

outcomes before and after the new guidelines were evaluated. Results: We included 230 LR-IR patients (159 before and 71 after) with 54 HR patients (33 before and 21 after). Pelvic lymphadenectomy was performed before and after the new guidelines in 123/159 (77.4%) and 20/71 (28.6%) patients, respectively (P b 0.001) in LH-IR. After 2010, eight patients with LH-IR also underwent secondary paraaortic lymphadenectomy for lymphovascular space invasion (LVSI), based on definitive histology. Overall survival (OS) and relapse-free survival (RFS) were similar before and after the new guidelines. In LR-RI patients, LVSI was an independent factor for OS (HR= 7.2, 95% CI: 3.1–17, P b 0.001) and RFS (HR= 3.7, 95% CI: 1.6–8.5, P b 0.003). After 2010, optimallymanaged LR-IR patients had similar OS anda higher 2-year RFS compared to suboptimally managed patients (OS: 100% vs. 98.1% [87.1– 99.7], P=0.6; RFS: 94.1% [82.7–98.1] vs. 77.1% [44.2–92.1], P=0.07). Conclusions: Fewer pelvic lymphadenectomies in LR-IR patients did not affect morbidity, OS, or RFS, and staged surgery did not affect morbidity or survival. However, a trend toward increased risk of recurrence was observed in patients who were not optimally managed per the new guidelines. Therefore, we must gather additional data, with a longer follow-up, to confirm our results.