Comparison of survival of patients with endometrial cancer treated with systematic lymphadenectomy versus sentinel lymph node biopsy alone

Background:

The survival of lymphadenectomy (LND) in endometrial cancer (EC) is still unclear. In the present study we aimed to compare the survival of patients with EC treated with two different methods for nodal staging: systematic pelvic and para-aortal lymphadenectomy (LND) and sentinel lymph node mapping only (SLN). The lymphatic pathways were mapped.

Methods:

All patients underwent hysterectomy with salpingo-oophorectomy. In the control group the patients underwent standard staging by systematic LND. In the study group the staging was performed only by SLN without completing LND even in a case of sentinel lymph node metastasis. SLN was performed with indocyanine green (ICG) after preoperative cervical injection.

Results:

Fifty two patients with EC underwent staging with SNB and were matched for age, tumor histology and grade, tumor stage, lymph and vascular space invasion and adjuvant therapy with 52 patients treated with systematic LND. Recurrent disease was observed in 9.6% and 15.4% in SLN and LND group, respectively (p = 0.555). 3-year disease-free survival (DFS) estimated 90.4% for SLN and 84.6% for LND. In the SLN Group 149 lymph nodes were removed and the bilateral detection rate was 97.5%. Sentinel lymph node metastasis was detected 13.4%. The main draining pathway was the upper paracervical pathway with common mapping of sentinel lymph nodes along external iliac vein and in the obturator region.

Conclusion:

SLN is excellent method for staging EC with very good survival outcome. However, the clinical impact of SLN strategy should be further evaluated in prospective studies.