Lymphadenectomy in Endometrial Cancer: Present Status

Abstract

The standard management of early-stage endometrial cancer includes surgical staging which comprises of total hysterectomy, bilateral salpingo-oophorectomy, and lymph node assessment. Lymph node evaluation in surgical staging generally consists of bilateral pelvic nodal dissection with or without para-aortic lymph node dissection. Lymphadenectomy helps provide prognostic information, stage the disease, and direct adjuvant treatment. It also provides therapeutic benefit by removing metastatic disease in the involved nodes. However, the therapeutic role of lymphadenectomy in women with negative nodes is debatable. Complete lymphadenectomy is also associated with morbidity including lower limb lymphedema. Selective use of lymphadenectomy is now recommended in early-stage endometrial cancer, as it can reduce the morbidity associated with routine lymph node dissection without compromising clinical outcomes, and also help avoid overtreatment in low-risk cases. Sentinel lymph node mapping has emerged as a useful alternative to lymphadenectomy in low-risk, uterus confined endometrial cancer. This chapter discusses the current evidence and recent guidelines on lymphadenectomy in endometrial cancer including sentinel lymph node biopsy.