Sentinel Lymph Node Mapping in Early-Stage Epithelial Ovarian Cancer Surgery

This prospective study aims to evaluate the feasibility and diagnostic performance of sentinel lymph node (SLN) mapping using indocyanine green (ICG) in patients undergoing surgery for early-stage epithelial ovarian cancer. Ovarian cancer is the most lethal gynecologic malignancy, and although systematic pelvic and paraaortic lymphadenectomy is considered a standard component of surgical staging. Moreover, systematic lymphadenectomy is associated with increased operative time, perioperative morbidity, and long-term complications such as lymphedema, without clear evidence of therapeutic benefit. SLN mapping has been successfully implemented in other gynecologic malignancies and may provide a less invasive alternative for lymph node assessment. In this study, patients undergoing laparotomy for adnexal masses will receive intraoperative ICG injection into the infundibulopelvic ligament on the affected side and into the cervix (at the 3 and 9 o'clock positions) following intraoperative confirmation of malignant epithelial tumor by frozen section analysis. SLN detection rates, anatomical distribution, and feasibility will be assessed. In addition, intraoperative and postoperative outcomes and potential complications related to the procedure will be evaluated. The results of this study are expected to contribute to the current evidence regarding the role of SLN mapping in early-stage epithelial ovarian cancer and may help reduce the need for systematic lymphadenectomy and its associated morbidity.

Sex

Female

Minimum age

18 Years

Maximum age

90 Years

Inclusion Criteria:

* Female patients aged 18-90 years
* Patients undergoing laparotomy for unilateral or bilateral adnexal mass
* Intraoperative frozen section diagnosis of malignant epithelial ovarian tumor or at least borderline epithelial tumor
* Patients with bilateral adnexal masses who have undergone preoperative gastrointestinal evaluation (endoscopy/colonoscopy) with exclusion of gastrointestinal malignancies
* Patients without radiological evidence of advanced-stage ovarian cancer on preoperative imaging (PET, MRI, or CT), including absence of pleural effusion, omental cake, peritoneal carcinomatosis, malignant ascites, liver or splenic parenchymal involvement, and mesenteric involvement
* Patients who provide written informed consent

Exclusion Criteria:

* Patients with prior lymphadenectomy
* Patients with radiological or intraoperative evidence of advanced-stage ovarian cancer
* Patients planned for neoadjuvant chemotherapy without primary surgery
* Pregnant patients
* Patients with known allergy to indocyanine green (ICG) or iodine
* Patients with immunodeficiency disorders
* Patients with a history of radiotherapy
* Patients with a history of vascular surgery affecting lymphatic drainage
* Patients with a history of vascular surgery affecting lymphatic drainage
* Patients with a history of non-gynecological malignancy
* Patients younger than 18 years or older than 90 years