Sentinel lymph node identification in prostate cancer


Prof. Pierre Monod, head of the Center of Oncourology at EMC's Urology Clinic, together with Maksim Smolyarchuk, head of the Center for Nuclear Medicine Diagnostics performed a unique procedure to identify sentinel lymph nodes in prostate cancer. The procedure was performed with a diagnostic isotope of technetium that is harmless to humans and selectively accumulates in the lymph nodes. 
Patients with prostate cancer, a primary metastasis (spread of the tumor) occurs in the lymph nodes of the pelvis, to an area known as the iliac fossa. These "sentinel" lymph nodes are the first obstacle to the tumor's further spread throughout the body. During a radical prostatectomy (complete surgical removal of the prostate) these lymph nodes are removed in patients with suspected lymph node metastasis on CT or MRI. 
Unfortunately, apart from the iliac lymph nodes, a tumor can also spread to other pelvic lymph nodes. And if this spread goes unnoticed, it can lead to cancer progression, endangering the patient's life. To avoid this, a method of radioisotope tracing was developed to identify the most likely lymph nodes to which a tumor might spread. 
During the procedure, the technetium isotope was injected directly into the patient's prostate, then using a special radiation detector, with the patient still on the operating table, the lymph nodes accumulating the technetium isotope were identified. These lymph nodes were removed using the da Vinci surgical robot. Presacral lymph nodes were among those removed, which are absolutely atypical for the spread of prostate cancer. If the physicians had not used this technique, the affected lymph nodes would have been left in the patient's body, creating a potential risk to the patient's health and life.  
The patient was discharged from the clinic on the third day, which is normal after a robotic radical prostatectomy.


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