Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas-A Systematic Review and Meta-Analysis.

Rianne J.A Helgers,Bjorn Winkens,Henrica M.J Werner,Brigitte F.M Slangen

doi:10.3390/jcm10010120

Rianne J.A Helgers, Bjorn Winkens + Show 2 more

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https://doi.org/10.3390/jcm10010120

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Abstract

Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma. Methods: A systematic search was conducted in PubMed and Cochrane Library. Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01–0.37; p = 0.067), 0.07 (95% CI 0.00–1.21; p = 0.007) and 0.54 (95% CI 0.37–0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28–0.96; I2 = 0%; p = 0.04). Conclusions: There are strong indications that SLN results in a lower incidence of lower-extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.

Highlights

Endometrial cancer (EC) is the second most common gynecologic malignancy and the fourth leading cause of cancer death in women worldwide, with 382,069 new cases and 89,929 deaths in 2018 [1]
Lymph node dissection (LND) does not improve survival according to two performed randomized trials, and results in increased peri- and post-operative morbidity compared to hysterectomy and bilateral salpingo-oophorectomy alone, including extended operating time and risk of lower-extremity lymphedema [9,12,13,14]
A systematic search was conducted in the PubMed and the Cochrane Library databases by two of the authors (R.J.A.H. and H.M.J.W.) between September 29, 2019 and March 18, 2020 to find studies examining the effect of the sentinel lymph node (SLN) versus LND on lower-extremity lymphedema and post-operative complications in EC

Summary

Introduction

Endometrial cancer (EC) is the second most common gynecologic malignancy and the fourth leading cause of cancer death in women worldwide, with 382,069 new cases and 89,929 deaths in 2018 [1]. LND does not improve survival according to two performed randomized trials, and results in increased peri- and post-operative morbidity compared to hysterectomy and bilateral salpingo-oophorectomy alone, including extended operating time and risk of lower-extremity lymphedema [9,12,13,14]. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma. Three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01–0.37; p = 0.067), 0.07 (95% CI 0.00–1.21; p = 0.007) and 0.54 (95% CI 0.37–0.80; p = 0.002) in these studies. Conclusions: There are strong indications that SLN results in a lower incidence of lowerextremity lymphedema and less often severe post-operative complications compared to LND. These results support the increasing uptake of SLN procedures in endometrial cancer

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Results

Conclusion