title: Lower-limb drainage mapping for lymphedema risk reduction after pelvic lymphadenectomy for endometrial cancer.
abstract: OBJECTIVE
  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 to map lower-limb drainage and to assess the diagnostic value of our mapping technique.
  
  
  METHODS
  This prospective study included patients with endometrial cancer requiring pelvic lymphadenectomy, without neoadjuvant radiotherapy or chemotherapy and without history of lower-limb surgery. A radiopharmaceutical was injected into both feet on the day before surgery. LLDNs were identified using preoperative lymphoscintigraphy and intraoperative isotopic probe detection, then removed before complete pelvic lymphadenectomy. LLDNs and pelvic lymphadenectomy specimens underwent separate histological analysis.
  
  
  RESULTS
  Of the 12 patients with early-stage endometrial cancer, 10 underwent preoperative lymphoscintigraphy, which consistently identified inguinal, femoral, and pelvic LLDNs (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.
  
  
  CONCLUSIONS
  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.
authors: Department of Medicine, INSERM UMR-S 747, Université Paris Descartes, Faculté de Médecine, Sorbonne Paris Cité, Paris, France. anne-sophie.bats@egp.aphp.fr
authors: Anne-Sophie
authors: AS
authors: Bats
authors: Claude
authors: C
authors: Nos
authors: Chérazade
authors: C
authors: Bensaïd
authors: Marie-Aude
authors: MA
authors: Le Frère-Belda
authors: Marie-Anne
authors: MA
authors: Collignon
authors: Marc
authors: M
authors: Faraggi
authors: Fabrice
authors: F
authors: Lécuru
mesh_terms: D000368:Aged; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007866:Leg / Q000033:anatomy & histology / Q000098:blood supply* / Q000473:pathology; D008197:Lymph Node Excision / Q000379:methods*; D008209:Lymphedema / Q000175:diagnosis / Q000473:pathology / Q000517:prevention & control / Q000628:therapy*; D008875:Middle Aged; D010388:Pelvis / Q000601:surgery; D010865:Pilot Projects; D011446:Prospective Studies; D012307:Risk Factors; D015899:Tomography, Emission-Computed, Single-Photon