Sentinel Lymph Node Biopsy for Early Stage Endometrial and Cervical Cancer Performed By Surgeons in Training

Abstract

Study Objective The aim of this study was to evaluate the results of the sentinel lymph node (SLN) biopsy performed by doctors in training. Design Prospective single-armed interventional study. Setting All sequential patients treated in a referral cancer center, from 2016 to 2020. IRB approved. Patients or Participants 126 patients, over 18y.o., with a prior diagnosis of initial endometrial (EC) or cervical (CC) cancer. Interventions Patients were submitted to SLN biopsy performed by surgical oncology residents or gynecologic oncology fellows, under direct supervision of a qualified preceptor. SLN was detected with blue dye with or without scintigraphy. Measurements and Main Results Patients underwent surgery by laparotomy - 22 surgeries (17.46%), by laparoscopy - 86 (81.13%) and by robotic - 18 (16.98%). SLN detection rate was 84.1% (n=106), bilateral in 53% (n=67) and mostly in younger patients (59.7% under 60y.o., p=0.022). There was a higher failure rate (non or unilateral detection) among older than 60y.o. (p=0.0075, CI:0.1656-0.7928, OR:0.3664). Among non-smokers, there was a greater bilateral detection of LNS (60.3%), and, among smokers, more cases of detection failure (59.4%). In 3 cases, the SLN was not identified, and there were positive pelvic nodes in the lymphadenectomy. There were no cases with positive nodes at lymphadenectomy with a negative SLN (false-negative). Mean surgical time was 217min and mean blood loss 116cc. Four patients had grade 3 complications, and none died. Conclusion We have demonstrated that residents and fellows can safely perform SLN biopsy for initial CC and EC under the direct supervision of a trained surgeon. Detection rates were aligned to the literature, and there were no false negatives. Lymph node positivity, age over 60y.o. and smoking were associated with a higher SLN non-detection rate.