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Multicenter Study
. 2024 Sep;50(9):108467.
doi: 10.1016/j.ejso.2024.108467. Epub 2024 Jun 8.

Sentinel node mapping, sentinel node mapping plus back-up lymphadenectomy, and lymphadenectomy in Early-sTage cERvical caNcer scheduled for fertilItY-sparing approach: The ETERNITY project

Giorgio Bogani  1 , Giovanni Scambia  2 , Anna Fagotti  2 , Francesco Fanfani  2 , Andrea Ciavattini  3 , Francesco Sopracordevole  4 , Mario Malzoni  5 , Jvan Casarin  6 , Fabio Ghezzi  6 , Enrico Vizza  7 , Francesco Cosentino  8 , Roberto Berretta  9 , Ilaria Cuccu  10 , Filippo Alberto Ferrari  11 , Valentina Chiappa  12 , Giuseppe Vizzielli  13 , Francesco Raspagliesi  12 ; investigator of the ETERNITY trial
Collaborators, Affiliations
Multicenter Study

Sentinel node mapping, sentinel node mapping plus back-up lymphadenectomy, and lymphadenectomy in Early-sTage cERvical caNcer scheduled for fertilItY-sparing approach: The ETERNITY project

Giorgio Bogani et al. Eur J Surg Oncol. 2024 Sep.

Abstract

Objective: To investigate the safety of sentinel node mapping for patients with early-stage cervical cancer undergoing cervical conization plus nodal evaluation.

Methods: The ETERNITY project is a retrospective, multi-institutional study collecting data of patients with early-stage cervical cancer undergoing fertility-sparing treatment. Here, we compared outcomes related to three methods of nodal assessment: sentinel node mapping (SNM), SNM plus backup lymphadenectomy (SNM + LND); pelvic lymphadenectomy (LND).

Results: Charts of 123 patients (with stage IA1-IB1 cervical cancer) were evaluated. Median patients' age was 34 (range, 22-44) years. SNM, SNM + LND, and LND were performed in 32 (26 %), 31 (25.2 %), and 60 (48.8 %) patients, respectively. Overall, eight (6.5 %) patients were diagnosed with positive nodes. Two (3.3 %), three (9.7 %), and three (9.4 %) patients were detected in patients who had LND, SNM + LND, and SNM respectively. Considering the 63 patients undergoing SNM (31 SNM + LND and 32 SNM alone), macrometastases, micrometastases, and isolated tumor cells were detected in four (3.2 %), three (2.4 %), and one (0.8 %) patients, respectively. All patients with positive nodes discontinued the fertility sparing treatment. Other two patients (one (1.7 %) in the LND group and one (3.1 %) in the SNM group) required hysterectomy even after negative nodal evaluation. After a median follow-up of 53.6 (range, 1.3, 158.0) months, nine (7.3 %) and two (1.6 %) patients developed cervical and pelvic nodes recurrences, respectively. Disease-free (p = 0.332, log-rank test) and overall survival (p = 0.769, log-rank test) were similar among groups.

Conclusions: In this retrospective experience, SNM upholds long-term oncologic effectiveness of LND, reducing morbidity.

Keywords: Cervical cancer; Conization; Fertility-sparing; Lymphadenectomy; Sentinel node.

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