Sentinel Lymph Node in Cervical Cancer: Time to Move Forward

Vincent Balaya; Benedetta Guani; Basile Pache; Yves-Gérard Durand; Hélène Bonsang-Kitzis; Charlotte Ngô; Patrice Mathevet; Fabrice Lécuru


Chin Clin Oncol. 2021;10(2):18 

In This Article

Morbidity and Quality of Life

Full pelvic lymphadenectomy results in a high postoperative morbidity, especially lower limbs lymphedema. This morbidity is increased when circonflex iliac nodes are removed beyond external iliac nodes,[102] in patients with body-mass index higher than 25 kg/m2 or in case of adjuvant radiotherapy.[103,104] One of the main clinical benefit of SLN biopsy is the reduced morbidity associated with pelvic lymphadenectomy. In a prospective study, Niikura et al. have shown a decrease of lower limbs lymphedema rate in patients with SLN biopsy alone compared to those who underwent full lymphadenectomy (8,7% vs. 42%, P=0.03).[12] In the SENTICOL II trial, SLN biopsy induced less lymphovascular morbidity compared to SLN biopsy associated with pelvic lymphadenectomy (31.4% vs. 51.5%, P=0.0046) and less early postoperative neurologic symptoms (7.8% vs. 20.6% P=0.01) with similar 3-year disease-free survival.[11] In a retrospective study comparing 1,188 patients with bilateral pelvic lymphadenectomy to 100 patients with bilateral SLN biopsy, Lennox et al. highlighted that SLN biopsy was associated with shorter operative-time (2 vs. 2.8 h, P<0.001), less intraoperative blood loss (100 vs. 500 mL, P<0.001), less transfusion (0% vs. 23%, P<0.001), less post-operative infection (0% vs. 11%, P=0.001) and shorter hospital stay.[32]

Considering the young age of patients and the good prognosis of early-stage, quality of life of patients is of paramount importance. According to SF-36 scale, Gianoni et al. demonstrated trend for a better quality of life and less severe leg heaviness and leg fatigue when a full pelvic lymphadenectomy was avoided.[105]