Sentinel Lymph Node Mapping vs Systematic Lymphadenectomy for Endometrial Cancer: Surgical Morbidity and Lymphatic Complications

Guilherme S Accorsi; Luiza L Paiva; Ronald Schmidt; Marcelo Vieira; Ricardo Reis; Carlos Andrade

doi:10.1016/j.jmig.2019.07.030

Sentinel Lymph Node Mapping vs Systematic Lymphadenectomy for Endometrial Cancer: Surgical Morbidity and Lymphatic Complications

J Minim Invasive Gynecol. 2020 May-Jun;27(4):938-945.e2. doi: 10.1016/j.jmig.2019.07.030. Epub 2019 Aug 14.

Authors

Guilherme S Accorsi¹, Luiza L Paiva², Ronald Schmidt², Marcelo Vieira², Ricardo Reis², Carlos Andrade²

Affiliations

¹ Department of Gynecologic Oncology of Barretos Cancer Hospital, Brazil (all authors). Electronic address: dr.guilhermeaccorsi@gmail.com.
² Department of Gynecologic Oncology of Barretos Cancer Hospital, Brazil (all authors).

PMID: 31421249
DOI: 10.1016/j.jmig.2019.07.030

Abstract

Study objective: Sentinel lymph node (SLN) mapping has been proven to accurately stage endometrial cancer (EC). However, there is a lack of studies comparing the incidence of complications between different lymph node approaches in EC. The objective of the study was to define the complication rates of SLN biopsy in EC patients.

Design: A retrospective cohort study SETTING: A tertiary referral hospital PATIENTS: All patients who were surgically treated for EC form April 2013 to March 2018 INTERVENTIONS: Authors evaluated intraoperative complications and 30-day complications using the Memorial Sloan Lettering Cancer Center's Surgical Secondary Events Grading System, separating the patients into 4 groups: group I, hysterectomy (HT); group II, hysterectomy plus sentinel lymph node biopsy (HT+SLN); group III, hysterectomy plus pelvic lymphadenectomy, with or without para-aortic dissection (HT+LND); and group IV, hysterectomy plus lymphadenectomy and sentinel lymph node biopsy (HT+SLN+LND).

Measurements and main results: Authors identified a total of 250 cases. As compared with the HT group, the HT+SLN group did not show any increased risk of complications in terms of intraoperative complications (0 vs 1; p = 1.0) and 30-day complications (8 vs 7; p = .782), but surgical time was approximately 20 minutes longer (p = .016). Performing LND was associated with a greater risk of 30-day complications (hazard ratio [HR]: 3.11; 95% confidence interval [CI]: 1.62-5.98), intraoperative complications (HR: 14.25; 95% CI: 1.85-19.63), and lower-limb lymphedema (HR: 8.14; 95% CI: 1.01-65.27).

Conclusion: SLN mapping does not increase morbidity in the surgical treatment of EC patients, and compared with comprehensive lymphadenectomy, it has a lower risk of complications. Our findings support the use of the SLN algorithm in EC patients.

Keywords: Endometrial carcinoma; Endometrial neoplasm; Lymph node biopsy; Lymph node dissection; Sentinel biopsy; Sentinel lymph node.

MeSH terms

Endometrial Neoplasms* / pathology
Endometrial Neoplasms* / surgery
Female
Humans
Intraoperative Complications / surgery
Lymph Node Excision / adverse effects
Lymph Nodes / pathology
Lymph Nodes / surgery
Morbidity
Neoplasm Staging
Retrospective Studies
Sentinel Lymph Node Biopsy / adverse effects
Sentinel Lymph Node* / pathology
Sentinel Lymph Node* / surgery