Intraoperative, radio-guided sentinel lymph node mapping in laparoscopic lymph node dissection for stage I testicular carcinoma

Makoto Satoh, Akihiro Ito, Yasuhiro Kaiho, Haruo Nakagawa, Seiichi Saito, Mareyuki Endo, Chikara Ohyama, Yoichi Arai

Research output: Contribution to journalArticlepeer-review

25 Citations (Scopus)

Abstract

BACKGROUND. The management of regional lymph nodes in patients with clinical Stage I testicular carcinoma is a controversial problem. The authors investigated the feasibility and accuracy of radio-guided mapping of sentinel lymph nodes (SLNs) for men with clinical Stage I testicular tumors. METHODS. Twenty-two patients with clinical Stage I testicular carcinoma were enrolled in the study. One day before surgery, 99mTechnetium-labeled phytate was injected around the testicular tumor. After undergoing radical orchiectomy, patients underwent laparoscopic retroperitoneal lymph node dissection (L-RPLND). All radioactive lymph nodes were marked in the L-RPLND procedure, and three-dimensional SLN maps were made. All resected lymph nodes were evaluated by routine histopathologic examination, and the clinical significance of intraoperative SLN mapping was evaluated. RESULTS. SLNs were detected in 21 of 22 patients (95%). Nearly all SLNs were detected at the ventral or lateral side of the vena cava or at the aorta between the levels of the aortic bifurcation. All SLNs were detected easily in a surgical procedure. Only 1 radio-positive area per patient was identified in 15 patients, and approximately 2-4 positive areas were detected in 6 patients. Two patients had micrometastasis only in SLNs. In 2 patients who had seminoma, lymph node recurrences (at the level of the renal vein and in the obturator lymph node area) occurred at 10 months and 20 months after surgery. CONCLUSIONS. Radio-guided mapping of SLNs with laparoscopy was feasible, and nearly all SLNs were detected accurately by the procedure. In the near future, the standard retroperitoneal lymph node dissection may be avoided in most patients with clinical Stage I testicular carcinoma by utilizing focused examination of SLNs.

Original languageEnglish
Pages (from-to)2067-2072
Number of pages6
JournalCancer
Volume103
Issue number10
DOIs
Publication statusPublished - 2005 May 15

Keywords

  • Laparoscopy
  • Lymph node dissection
  • Sentinel lymph node
  • Testicular carcinoma
  • γ probe

ASJC Scopus subject areas

  • Oncology
  • Cancer Research

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