Gynecologic oncologists at Dana-Farber/Brigham and Women’s Cancer Center have adopted the practice of sentinel lymph node (SLN) mapping for staging in endometrial adenocarcinoma. In October 2016, Colleen M. Feltmate, MD, Director of Minimally Invasive Gynecologic Surgery for the Division of Gynecologic Oncology, presented the data from their study comparing cohorts using SLN versus selective lymphadenectomy in this patient population at the International Gynecologic Cancer Society (IGCS) Meeting in Lisbon, Portugal.
“There remains limited information on how the introduction of SLN mapping impacts heterogeneity in surgical staging practice, so evaluation of these approaches is paramount,” said Dr. Feltmate.
The team compared a subset of patients who underwent selective lymphadenectomy at Brigham and Women’s Hospital between January 2014 and October 2015 with a group of patients who underwent SLN mapping at BWH between October 2015 and September 2016. They found that the adoption of the SLN approach increased the percentage of women undergoing nodal assessment while standardizing the approach to nodal evaluation among both low risk and high risk cases.
Results from this study revealed a higher detection rate of positive lymph nodes in the SLN group. However, while more patients underwent nodal evaluation in the SLN group, fewer lymph nodes ovarall were removed per patient. This group also had shorter operative time, less blood loss, and fewer complications. Results of the study are expected to be published in 2017.
“Our findings are significant because nodal metastases in endometrial cancer are associated with lower overall survival,” said Dr. Feltmate. “Even among women with apparently low grade, early stage disease, there is a risk of hidden nodal metastases.” Adoption of SLN protocols may therefore lead to a less invasive, more consistent and reproducible approach to stratifying patient risk in endometrial cancer.
Dr. Feltmate and gynecologic oncologist Michael G. Muto, MD, perform SLN mapping using both laparoscopic and robotic approaches, enabling flexibility in selecting the most appropriate technology for each patient. There are several benefits with conventional laparoscopy, including fewer incisions than the robotic technique, faster operating time and improved immediate postoperative recovery, with patients returning home the same day as the procedure. “Endometrial cancer is the most common gynecologic malignancy,” said Dr. Feltmate. “Practice changes like these can revolutionize the way we treat women with this disease.”
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