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Denis QUERLEU

Institut Claudius Regaud
Toulouse, France
MD
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Sentinel node technique in uterine cancers (update of April 2012 lecture)
Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis.
Total hysterectomy and bilateral salpingo-oophorectomy with or without a lymph node dissection is the standard method in the management of endometrial cancer. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging, resulting in detrimental side-effects, including lower extremity lymphedema. SLN mapping is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. Among gynecological cancers, a variety of methods have been described to detect a sentinel node in situ including colored dyes and radioisotopes, the latter requiring a specialized gamma detection probe. In this key presentation, Dr. Querleu will talk about the SNL technique in uterine cancers.
Lecture
2 years ago
1449 views
131 likes
0 comments
34:36
Sentinel node technique in uterine cancers (update of April 2012 lecture)
Endometrial cancer is the most common gynecologic malignancy. In the majority of patients, the disease will present at an early stage, without metastasis, and with an excellent prognosis.
Total hysterectomy and bilateral salpingo-oophorectomy with or without a lymph node dissection is the standard method in the management of endometrial cancer. Although the rate of metastasis in patients with early stage endometrial cancer is low, the standard of treatment still includes a complete or selective pelvic and para-aortic lymphadenectomy for staging, resulting in detrimental side-effects, including lower extremity lymphedema. SLN mapping is based on the concept that lymph node metastasis is the result of an orderly process, that is, the lymph drains in a specific pattern away from the tumor, and therefore if the SLN, or first node, is negative for metastasis, then the nodes after the SLN should also be negative. Among gynecological cancers, a variety of methods have been described to detect a sentinel node in situ including colored dyes and radioisotopes, the latter requiring a specialized gamma detection probe. In this key presentation, Dr. Querleu will talk about the SNL technique in uterine cancers.
Endometrial cancer surgical indications
The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while simultaneously expanding minimal access surgery to the obese and elderly populations. Sentinel lymph node detection and single port surgery are expanding areas which will continue to push the role of minimally invasive surgery (MIS) in endometrial cancer. In this key lecture, Dr. Querleu will discuss the role of MIS in the management of endometrial cancer.
Lecture
2 years ago
1404 views
102 likes
0 comments
29:34
Endometrial cancer surgical indications
The surgical management of endometrial cancer has been markedly changed by minimally invasive techniques. After three decades of laparoscopy, robotic surgery has built upon and expanded the population of patients able to benefit from minimally invasive techniques. Updates in the field of laparoscopy continue, including single site surgery. The emergence and rapid uptake of robotics continues to produce favorable outcomes while simultaneously expanding minimal access surgery to the obese and elderly populations. Sentinel lymph node detection and single port surgery are expanding areas which will continue to push the role of minimally invasive surgery (MIS) in endometrial cancer. In this key lecture, Dr. Querleu will discuss the role of MIS in the management of endometrial cancer.
Sentinel node technique in uterine cancers
Standard full pelvic lymph node dissection is a simple operation but with potential complications, such as lymphedema, which can be very disturbing for the patient. Additionally, even full pelvic dissection may miss the so-called “ectopic nodes”. Moreover, if a large number of nodes are sent for pathological exam, the pathologist is unable to perform serial sections and immunohistochemistry (IHC) to all nodes. For that reason, the pathologist could well miss positive nodes.
On the other hand, the sentinel node technique is able to detect the nodes that are not included in standard pelvic node dissection. It is also able to diagnose micro-metastasis on serial sections.
This technique, which is performed laparoscopically, uses blue dye combined with radio-isotopic identification and mapping, potentially associated with planar lymphoscintigraphy and SPECT-CT. In this way, it is possible to also detect “hot” nodes that are not colored by blue dye. The injection is performed in each quadrant of the cervix, approximately 2mm deep in the stroma.
In the near future, the sentinel node will probably have become the only one to be removed in early cervical cancer as well as in low and intermediate risk endometrial cancer.
Lecture
7 years ago
1639 views
19 likes
0 comments
28:53
Sentinel node technique in uterine cancers
Standard full pelvic lymph node dissection is a simple operation but with potential complications, such as lymphedema, which can be very disturbing for the patient. Additionally, even full pelvic dissection may miss the so-called “ectopic nodes”. Moreover, if a large number of nodes are sent for pathological exam, the pathologist is unable to perform serial sections and immunohistochemistry (IHC) to all nodes. For that reason, the pathologist could well miss positive nodes.
On the other hand, the sentinel node technique is able to detect the nodes that are not included in standard pelvic node dissection. It is also able to diagnose micro-metastasis on serial sections.
This technique, which is performed laparoscopically, uses blue dye combined with radio-isotopic identification and mapping, potentially associated with planar lymphoscintigraphy and SPECT-CT. In this way, it is possible to also detect “hot” nodes that are not colored by blue dye. The injection is performed in each quadrant of the cervix, approximately 2mm deep in the stroma.
In the near future, the sentinel node will probably have become the only one to be removed in early cervical cancer as well as in low and intermediate risk endometrial cancer.
Richter's sacrospinous ligament fixation of the prolapsed vaginal vault
The description of the Richter's sacrospinous ligament fixation of the prolapsed vaginal vault covers all aspects of the surgical procedure used for the management of vaginal vault prolapse following hysterectomy.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: posterior colpotomy, opening of fossae, exposure, sutures, checking the hemostasis, myorrhaphy, suspension of vaginal floor, end of procedure, complications.
Consequently, this operating technique is well standardized for the management of this condition.
Operative technique
17 years ago
3189 views
112 likes
1 comment
Richter's sacrospinous ligament fixation of the prolapsed vaginal vault
The description of the Richter's sacrospinous ligament fixation of the prolapsed vaginal vault covers all aspects of the surgical procedure used for the management of vaginal vault prolapse following hysterectomy.
Operating room set up, position of patient and equipment, instruments used are thoroughly described. The technical key steps of the surgical procedure are presented in a step by step way: posterior colpotomy, opening of fossae, exposure, sutures, checking the hemostasis, myorrhaphy, suspension of vaginal floor, end of procedure, complications.
Consequently, this operating technique is well standardized for the management of this condition.