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Abstract：
UNASSIGNED: Discrepancies exist among international guidelines on the surgical staging of para-aortic lymph nodes in locally advanced cervical cancer (LACC), varying from considering a para-aortic lymph node dissection, at least up to the inferior mesenteric artery, to a complete para-aortic lymph node dissection. In this study, we aim to assess the reproducibility of our recently reported robotic technique using indocyanine green for identifying besides primary pelvic sentinel lymph nodes (SLNs), secondary para-aortic SLNs in a first case-cohort of cervical cancer patients.
UNASSIGNED: A retrospective case series of LACC patients with/without suspicious pelvic lymph nodes (LNs) on imaging (including two patients with an additional suspicious para-aortic LN) is reported. All patients underwent a robotic pelvic SLN and para-aortic sentinel/nonsentinel LN dissection using the da Vinci Xi platform. Indocyanine green was used as a fluorescent tracer, at a concentration of 1.9 mg/mL, and injected as 0.5 mL in each quadrant of the cervix.
UNASSIGNED: In a total of 10 cases, primary pelvic SLNs (90% bilateral) with subsequent secondary para-aortic SLNs were identified in all cases. Lower para-aortic SLNs were present in all cases, and upper para-aortic SLNs were found in 9 out of 10 cases. The mean age of the cervical cancer patients was 49.8 years (SD ± 6.89), and the mean body mass index (BMI; kg/m2) was 23.96 (SD ± 4.60). The median total operative time was 105.5 min (range: 89-141 min). The mean numbers of primary pelvic SLNs and secondary lower and upper para-aortic SLNs were 3.10 (SD ± 1.10), 2.90 (SD ± 0.74), and 2.30 (SD ± 1.57), respectively. The median number of total para-aortic LNs (PALNs) dissected per patient was 11.5. Six patients had positive primary pelvic SLNs, and two had secondary positive para-aortic SLNs. The nonsentinel para-aortic LNs were negative in all cases. There were no intra- or postoperative complications.
UNASSIGNED: Our preliminary experience demonstrates the reproducibility of identifying, besides primary pelvic SLNs, secondary lower and upper para-aortic SLNs during robotic staging in LACC. A surgical approach limiting a complete para-aortic LN dissection could reduce the potential risks and morbidity associated with this procedure. To determine the sensitivity and negative predictive value of this new surgical approach, and whether the lower para-aortic SLNs under the inferior mesenteric artery are representative of the whole para-aortic region, large prospective observational studies are needed in LACC and/or those with suspicious pelvic LNs but apparent normal para-aortic LNs on imaging.
UNASSIGNED: A retrospective case series of LACC patients with/without suspicious pelvic lymph nodes (LNs) on imaging (including two patients with an additional suspicious para-aortic LN) is reported. All patients underwent a robotic pelvic SLN and para-aortic sentinel/nonsentinel LN dissection using the da Vinci Xi platform. Indocyanine green was used as a fluorescent tracer, at a concentration of 1.9 mg/mL, and injected as 0.5 mL in each quadrant of the cervix.
UNASSIGNED: In a total of 10 cases, primary pelvic SLNs (90% bilateral) with subsequent secondary para-aortic SLNs were identified in all cases. Lower para-aortic SLNs were present in all cases, and upper para-aortic SLNs were found in 9 out of 10 cases. The mean age of the cervical cancer patients was 49.8 years (SD ± 6.89), and the mean body mass index (BMI; kg/m2) was 23.96 (SD ± 4.60). The median total operative time was 105.5 min (range: 89-141 min). The mean numbers of primary pelvic SLNs and secondary lower and upper para-aortic SLNs were 3.10 (SD ± 1.10), 2.90 (SD ± 0.74), and 2.30 (SD ± 1.57), respectively. The median number of total para-aortic LNs (PALNs) dissected per patient was 11.5. Six patients had positive primary pelvic SLNs, and two had secondary positive para-aortic SLNs. The nonsentinel para-aortic LNs were negative in all cases. There were no intra- or postoperative complications.
UNASSIGNED: Our preliminary experience demonstrates the reproducibility of identifying, besides primary pelvic SLNs, secondary lower and upper para-aortic SLNs during robotic staging in LACC. A surgical approach limiting a complete para-aortic LN dissection could reduce the potential risks and morbidity associated with this procedure. To determine the sensitivity and negative predictive value of this new surgical approach, and whether the lower para-aortic SLNs under the inferior mesenteric artery are representative of the whole para-aortic region, large prospective observational studies are needed in LACC and/or those with suspicious pelvic LNs but apparent normal para-aortic LNs on imaging.
摘要：
■关于局部晚期宫颈癌（LACC）主动脉旁淋巴结手术分期的国际指南之间存在差异，与考虑主动脉旁淋巴结清扫术不同，至少到肠系膜下动脉,完整的主动脉旁淋巴结清扫术.在这项研究中,我们的目的是评估我们最近报道的机器人技术的可重复性，使用吲哚菁绿识别除了原发性盆腔前哨淋巴结（SLN），宫颈癌患者的第一个病例队列中的继发性主动脉旁SLN。
■报道了影像学上有/无可疑盆腔淋巴结（LNs）的LACC患者（包括两名额外的可疑主动脉旁LN患者）的回顾性病例系列。所有患者均使用达芬奇Xi平台进行了机器人骨盆SLN和主动脉前哨/非前哨LN解剖。吲哚菁绿被用作荧光示踪剂，浓度为1.9mg/mL，并在子宫颈的每个象限中以0.5mL注射。
■总共10例，在所有病例中均发现了原发性盆腔SLN(90%双侧)和随后的继发性主动脉旁SLN.所有病例均存在下主动脉旁SLN，10例中有9例发现上主动脉旁SLN。宫颈癌患者的平均年龄为49.8岁(SD±6.89),平均体重指数(BMI;kg/m2)为23.96(SD±4.60)。中位总手术时间为105.5分钟（范围：89-141分钟）。原发性盆腔SLN和继发性下、上主动脉旁SLN的平均数目为3.10(SD±1.10),2.90（标准差±0.74），和2.30(标准差±1.57)，分别。每位患者解剖的主动脉旁LN（PALN）总数的中位数为11.5。6例原发性盆腔SLN阳性，和两个有继发性阳性主动脉旁SLN。在所有情况下，非前哨主动脉旁LN均为阴性。没有术中或术后并发症。
■我们的初步经验证明了鉴定的可重复性，除了原发性骨盆SLN，LACC机器人分期期间的继发性下主动脉旁和上主动脉旁SLN。限制完整的主动脉旁LN夹层的手术方法可以降低与该手术相关的潜在风险和发病率。为了确定这种新手术方法的敏感性和阴性预测值，以及肠系膜下动脉下的主动脉旁SLN是否代表整个主动脉旁区域，对于LACC和/或有可疑盆腔LN但在影像学上明显正常的主动脉旁LN的患者,需要进行大型前瞻性观察性研究.
■报道了影像学上有/无可疑盆腔淋巴结（LNs）的LACC患者（包括两名额外的可疑主动脉旁LN患者）的回顾性病例系列。所有患者均使用达芬奇Xi平台进行了机器人骨盆SLN和主动脉前哨/非前哨LN解剖。吲哚菁绿被用作荧光示踪剂，浓度为1.9mg/mL，并在子宫颈的每个象限中以0.5mL注射。
■总共10例，在所有病例中均发现了原发性盆腔SLN(90%双侧)和随后的继发性主动脉旁SLN.所有病例均存在下主动脉旁SLN，10例中有9例发现上主动脉旁SLN。宫颈癌患者的平均年龄为49.8岁(SD±6.89),平均体重指数(BMI;kg/m2)为23.96(SD±4.60)。中位总手术时间为105.5分钟（范围：89-141分钟）。原发性盆腔SLN和继发性下、上主动脉旁SLN的平均数目为3.10(SD±1.10),2.90（标准差±0.74），和2.30(标准差±1.57)，分别。每位患者解剖的主动脉旁LN（PALN）总数的中位数为11.5。6例原发性盆腔SLN阳性，和两个有继发性阳性主动脉旁SLN。在所有情况下，非前哨主动脉旁LN均为阴性。没有术中或术后并发症。
■我们的初步经验证明了鉴定的可重复性，除了原发性骨盆SLN，LACC机器人分期期间的继发性下主动脉旁和上主动脉旁SLN。限制完整的主动脉旁LN夹层的手术方法可以降低与该手术相关的潜在风险和发病率。为了确定这种新手术方法的敏感性和阴性预测值，以及肠系膜下动脉下的主动脉旁SLN是否代表整个主动脉旁区域，对于LACC和/或有可疑盆腔LN但在影像学上明显正常的主动脉旁LN的患者,需要进行大型前瞻性观察性研究.
