Lower-LimbDrainageMapping for LymphedemaRiskReduction AfterPelvic Lymphadenectomy forEndometrial Cancer

Objectives. Pelvic lymphadenectomy is associated with a significant risk of lower-limb lymphedema. In this proof-of-concept study, we evaluated the feasibility of identifying the lower-limb drainage nodes (LLDNs) during pelvic lymphadenectomy for endometrial cancer. Secondary objectives were tomap lower-limbdrainageand toassess thediagnostic value of ourmapping technique. Methods. This prospective study included patients with endometrial cancer requiringpelvic lymphadenectomy,without neoadjuvant radiotherapy or chemotherapy and without history of lower-limb surgery. A radiopharmaceutical was injected into both feeton thedaybefore surgery. LLDNswere identifiedusing preoperative lymphoscintigraphy and intraoperative isotopic probe detection, then removed before complete pelvic lymphadenectomy. LLDNs and pelvic lymphadenectomy specimens underwent separatehistological analysis. Results.Of the 12 patients with early-stage endometrial cancer, 10 underwent preoperative lymphoscintigraphy, which consistently identified inguinal, femoral,andpelvicLLDNs(detection rate: 100%). The intraoperative detection rate was 83% (10/12). Median number of hot nodes per patient was 5 nodes (range: 3–7) on the right and 3 nodes (range: 2–6) on the left. Of 107 LLDNs, 106 were in the external iliac area, including 38 in the lateral group and 45 in the intermediate and medial groups. None of the patients had node metastases at any site. No early complications related to the technique occurred. Conclusion. Our mapping technique appears feasible, safe, and associated with a high LLDN identification rate. LLDN mapping may allow the preservation of LLDNs, thereby decreasing the risk of lower-limb lymphedema and improving quality of life. TheOncologist2013;18:174–179 Implications forPractice: Pelvic lymphadenectomy isassociatedwithsubstantialpostoperativemorbidity relatedtotheremoval of pelvic lower-limbdrainagenodes,whicharenot identifiedduring theprocedure. The sentinel nodebiopsy techniquehasbeen developed todecrease lymphadenectomy-relatedmorbidity. In somegynecological cancers, however, routinepelvic lymphadenectomy remains required. Our proof-of-concept study was designed to evaluate the feasibility of identifying the lower-limb drainagenodes (LLDNs)duringpelvic lymphadenectomy forendometrial cancer.Our resultsholdpromise forpreserving the lymphatic drainage pathways of the lower limbs. Sparing the LLDNsmaydecrease the risk of lower-limb lymphedema,which is associatedwith both a decrease in quality of life and additional healthcare costs.