Highlights
- •Sentinel node mapping (SNM) is accurate in identifying disease harboring in the lymph nodes in EC.
- •In comparison to hysterectomy only, the addiction of SNM does not increase morbidity rate.
- •The omission of retroperitoneal staging has no negative effect on influencing oncologic outcomes.
- •Recent advances in molecular studies have refined the prognosis for EC and uterine risk factors are the main variable influencing the need of adjuvant therapies.
- •In few EC patients (merely 4%) nodal status is the only factor used in determining appropriate adjuvant therapy.
Abstract
Objective
To compare outcomes after hysterectomy and hysterectomy plus sentinel node mapping
(SNM) in endometrial cancer (EC) patients.
Materials and methods
This is a retrospective study, collecting data of EC patients treated between 2006
and 2016 in nine referral centers.
Results
The study population included 398 (69.5%) and 174 (30.5%) patients having hysterectomy
and hysterectomy plus SNM. As the results of the adoption of a propensity-score matched
analysis, we selected two homogeneous cohort of patients (150 having hysterectomy
only vs. 150 having hysterectomy plus SNM). The SNM group had a longer operative time,
but did not correlate with length of hospital stay and estimated blood loss. Overall
severe complication rates were similar between groups (0.7% in the hysterectomy group
vs. 1.3% in the hysterectomy plus SNM group; p = 0.561). No lymphatic-specific complication
occurred. Overall, 12.6% of patients having SNM were diagnosed with disease harboring
in their lymph nodes. Adjuvant therapy administration rate was similar between groups.
Considering patients having SNM, 4% of patients received adjuvant therapy on the basis
of nodal status alone; all the other patients received adjuvant therapy also on the
basis of uterine risk factors. Five-year disease-free (p = 0.720) and overall (p = 0.632)
survival was not influenced by surgical approach.
Conclusions
Hysterectomy (with or without SNM) is a safe and effective method for managing EC
patients. Potentially, these data support the omission of side specific lymphadenectomy
in case of unsuccessful mapping. Further evidence is warranted in to confirm the role
SNM in the era of molecular/genomic profiling.
Keywords
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Article info
Publication history
Published online: February 13, 2023
Accepted:
February 12,
2023
Received in revised form:
January 11,
2023
Received:
August 23,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
