Why cette approche has transformed management
For decades, lymph node staging of pelvic gynaecological cancers relied on the systematic removal of the entire lymph node chain — lymphadenectomy. This extensive dissection exposes patients to a risk of lower-limb lymphoedema, a potentially long-lasting and disabling complication. The sentinel node has profoundly changed this approach.
The principle is physiological. The lymphatic spread of a tumour follows a precise anatomical pathway, reaching first the primary draining node — the sentinel node. When this node is clear after fine pathological analysis, the downstream nodes have a probability greater than 95% of also being clear. The targeted removal of the sentinel node alone is then sufficient, without needing to access the rest of the chain.
More sensitive pathological analysis. Standard lymphadenectomy involves analysis of 15 to 30 nodes by standard sections. The sentinel node surgical technique targets 2 to 4 nodes, examined in ultrastaging: serial sections every 200 microns with immunohistochemistry for cytokeratin staining. This method detects micrometastases (0.2 to 2 mm) and isolated tumour cells that could escape the standard analysis of a lymphadenectomy.
Patient benefits. Reduction of immediate sequelae (lower incidence of extensive pelvic lymphocele), shorter operative time, reduced hospital stay. The major benefit remains the reduction of lower limb lymphoedema risk, reduced by approximately five-fold compared to classic lymphadenectomy (from 10-20% to less than 5%).
