Comparison of survival of patients with endometrial cancer undergoing sentinel node biopsy alone or systematic lymphadenectomy

• Published in: Archives of gynecology and obstetrics 2020-10, Vol.302 (4), p.995-1000
• Main Authors: Ignatov, Atanas, Papathemelis, Thomas, Ivros, Stylianos, Ignatov, Tanja, Ortmann, Olaf, Eggemann, Holm
• Format: Article
• Language: English
• Subjects: Adult; Age; Aged; Aged, 80 and over; Biopsy; Cohort Studies; Endocrinology; Endometrial cancer; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Endometrial Neoplasms - secondary; Female; Gynecologic Oncology; Gynecology; Human Genetics; Humans; Hysterectomy; Lymph Node Excision - methods; Lymphatic system; Medical prognosis; Medicine; Medicine & Public Health; Metastasis; Middle Aged; Obstetrics/Perinatology/Midwifery; Oophorectomy; Prospective Studies; Retrospective Studies; Sentinel Lymph Node - surgery; Sentinel Lymph Node Biopsy - methods; Survival Analysis
• ISSN: 0932-0067; 1432-0711
• DOI: 10.1007/s00404-020-05698-w

Background Recently, sentinel lymph node mapping was introduced in the surgical staging of endometrial cancer as alternative to systematic lymphadenectomy. However, the survival impact of sentinel node mapping is not well characterized yet. Methods We performed retrospective study of 104 patients with endometrial cancer treated with sentinel lymph node alone ( n  = 52) or with pelvic and para-aortic lymphadenectomy ( n  = 52). For sentinel node mapping, indocyanine green was used. The outcome measure was disease-free survival. Results Median follow-up was 42 months. Fifty-two patients staged by sentinel lymph node mapping were matched in 1:1 ratio with 52 patients staged by lymphadenectomy using patient age, histological type, tumor stage, tumor grade and lymph and vascular space invasion as matching criteria. The median number of removed lymph node was 3 (range 1–6) and 36 (13–63) in the sentinel and lymphadenectomy group, respectively. The rate of lymph node metastases was not significantly higher in the sentinel group (19.2%) in comparison with the lymphadenectomy group (14.3%). The overall detection rate of sentinel lymph nodes was 100% with a bilateral mapping of 98.1%. Most of the 152 lymph nodes identified and removed were localized in upper paracervical pathway ( n  = 143, 94.1%). During the follow-up period, overall 21 (20.2%) events were observed, 8 (15.4%) in the sentinel group and 13 (25.0%) in the lymphadenectomy group. The estimated disease-free survival was 84.6% and 75.0% for patients in the sentinel and lymphadenectomy groups, respectively. The survival curves demonstrated similar disease-free survival in two groups ( p  = 0.774). Conclusion Sentinel lymph node mapping did not compromise the outcome of patients with endometrial cancer.