Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs

Amanika Kumar, Sumer A. Wallace, William Arthur Cliby, Gretchen E. Glaser, Andrea Mariani, Mario M. Leitao, Michael Frumovitz, Carrie L. Langstraat

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Study Objective: We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions. Design: Retrospective multi-institution cohort (Canadian Task Force classification II-2). Setting: Three tertiary cancer referral cancer centers. Patients: Patients with endometrial and vulvar cancer undergoing lymph node evaluation. Interventions: Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment. Measurements and Main Results: Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins. Conclusions: Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.

Original languageEnglish (US)
JournalJournal of Minimally Invasive Gynecology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Vulvar Neoplasms
Lymph Node Excision
Endometrial Neoplasms
Groin
Neoplasms
Thigh
Lymph Nodes
Sentinel Lymph Node Biopsy
Gynecologic Surgical Procedures
Medical Oncology
Advisory Committees
Medical Education
cyhalothrin
Referral and Consultation
Databases

Keywords

  • Endometrial cancer
  • Sentinel lymph nodes
  • Surgical training
  • Vulvar cancer

ASJC Scopus subject areas

  • Obstetrics and Gynecology

Cite this

Kumar, A., Wallace, S. A., Cliby, W. A., Glaser, G. E., Mariani, A., Leitao, M. M., ... Langstraat, C. L. (Accepted/In press). Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs. Journal of Minimally Invasive Gynecology. https://doi.org/10.1016/j.jmig.2018.08.006

Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs. / Kumar, Amanika; Wallace, Sumer A.; Cliby, William Arthur; Glaser, Gretchen E.; Mariani, Andrea; Leitao, Mario M.; Frumovitz, Michael; Langstraat, Carrie L.

In: Journal of Minimally Invasive Gynecology, 01.01.2018.

Research output: Contribution to journalArticle

Kumar, Amanika ; Wallace, Sumer A. ; Cliby, William Arthur ; Glaser, Gretchen E. ; Mariani, Andrea ; Leitao, Mario M. ; Frumovitz, Michael ; Langstraat, Carrie L. / Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs. In: Journal of Minimally Invasive Gynecology. 2018.
@article{98f2e656e6fe4e0fbc5ee1a8c3ee216e,
title = "Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs",
abstract = "Study Objective: We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions. Design: Retrospective multi-institution cohort (Canadian Task Force classification II-2). Setting: Three tertiary cancer referral cancer centers. Patients: Patients with endometrial and vulvar cancer undergoing lymph node evaluation. Interventions: Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment. Measurements and Main Results: Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100{\%} versus 68{\%} versus 24{\%}, respectively, of patients would require complete pelvic lymphadenectomy and 100{\%} versus 34{\%} versus 12{\%} would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81{\%} of unilateral groins to only 12{\%} of groins. Conclusions: Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.",
keywords = "Endometrial cancer, Sentinel lymph nodes, Surgical training, Vulvar cancer",
author = "Amanika Kumar and Wallace, {Sumer A.} and Cliby, {William Arthur} and Glaser, {Gretchen E.} and Andrea Mariani and Leitao, {Mario M.} and Michael Frumovitz and Langstraat, {Carrie L.}",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.jmig.2018.08.006",
language = "English (US)",
journal = "Journal of Minimally Invasive Gynecology",
issn = "1553-4650",
publisher = "Elsevier",

}

TY - JOUR

T1 - Impact of Sentinel Node Approach in Gynecologic Cancer on Training Needs

AU - Kumar, Amanika

AU - Wallace, Sumer A.

AU - Cliby, William Arthur

AU - Glaser, Gretchen E.

AU - Mariani, Andrea

AU - Leitao, Mario M.

AU - Frumovitz, Michael

AU - Langstraat, Carrie L.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Study Objective: We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions. Design: Retrospective multi-institution cohort (Canadian Task Force classification II-2). Setting: Three tertiary cancer referral cancer centers. Patients: Patients with endometrial and vulvar cancer undergoing lymph node evaluation. Interventions: Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment. Measurements and Main Results: Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins. Conclusions: Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.

AB - Study Objective: We sought to estimate the impact of sentinel nodes in gynecologic oncology on fellowship training and discuss potential solutions. Design: Retrospective multi-institution cohort (Canadian Task Force classification II-2). Setting: Three tertiary cancer referral cancer centers. Patients: Patients with endometrial and vulvar cancer undergoing lymph node evaluation. Interventions: Patient history and fellow case volumes were evaluated retrospectively for type of lymph node assessment. Measurements and Main Results: Minimally invasive endometrial cancer and vulvar cancer fellow case volumes in 3 large institutions were reviewed and average annual volumes calculated for each clinical gynecologic oncology fellow. For vulvar cancer, probabilities of sentinel lymph node mapping and laterality of lesions were estimated from the literature. For endometrial cancer, estimates of lymphadenectomy rates were determined using probabilities calculated from our historic database and from review of the literature. Modeling the approaches to lymphadenectomy in endometrial cancer (full, selective, and sentinel), 100% versus 68% versus 24%, respectively, of patients would require complete pelvic lymphadenectomy and 100% versus 34% versus 12% would require para-aortic lymphadenectomy. In vulvar cancer, rates of inguinal femoral lymphadenectomy are expected to drop from 81% of unilateral groins to only 12% of groins. Conclusions: Sentinel lymph node biopsy for endometrial and vulvar cancer will play an increasing role in practice, and coincident with this will be a dramatic decrease in pelvic, para-aortic, and inguinal femoral lymphadenectomies. The declining numbers will require new strategies to maintain competency in our specialty. New approaches to surgical training and continued medical education will be necessary to ensure adequate training for fellows and young faculty across gynecologic surgery.

KW - Endometrial cancer

KW - Sentinel lymph nodes

KW - Surgical training

KW - Vulvar cancer

UR - http://www.scopus.com/inward/record.url?scp=85053875894&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85053875894&partnerID=8YFLogxK

U2 - 10.1016/j.jmig.2018.08.006

DO - 10.1016/j.jmig.2018.08.006

M3 - Article

JO - Journal of Minimally Invasive Gynecology

JF - Journal of Minimally Invasive Gynecology

SN - 1553-4650

ER -