Laparoscopic indocyanine green sentinel lymph node mapping in early ovarian cancer. A pilot study and review of the literature

Objective: there are still few studies concerning the Sentinel lymph node (SLN) in ovarian cancer. In this pilot study we described the feasibility of SLN mapping with Indocyanine Green (ICG) in five patients affected by early stage ovarian cancer, during laparoscopic surgery. Material and Methods: the tracer has been injected into the hilum of the ovary through a spinal needle (22-gauge size) connected to 20 cm-long infusion tubing for intravenous fluid delivery advanced inside the lateral trocar (10 mm) through a Johann clamp. Results: a total of 6 SNs was detected in all patients. The median interval from the tracer injection to the detection of all SNs was 2 minutes (range, 1 - 3 minutes). In three patients, the first detected SN was found in the area of common iliac artery, in two patients at paracaval region. The median number of lymph nodes removed per patient was 2 (range, 0-2). All the detected SLNs were identified ipsilateral to the site of injection. Only in two patients we detected a second SLN, respectively in preaortic region and in under mesenteric region. No allergic reaction has occurred. Conclusions: ICG laparoscopic SLN mapping in early stage ovarian cancer is a procedure feasible and promising. Additional prospective multicenter studies are needed to evaluate the best technique for staging early stage ovarian cancer patients.