Sentinel Node Mapping Vs. Sentinel Node Mapping Plus Backup Lymphadenectomy in Endometrial Cancer: 3-Year Outcome

Abstract

Study Objective Sentinel node mapping (SLNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluate long-term survival of two different approaches of nodal assessment in EC. Design This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years) of EC patients having SLNM alone and SLNM followed by lymphadenectomy. In order to reduce possible confounding factors we applied a propensity-matched algorithm. Survival outcomes were assessed using Kaplan-Meier and Cox proportional hazard models. Setting Three oncologic referral centers. Patients or Participants Consecutive EC patients having minimally invasive surgical staging. Interventions Laparoscopic hysterectomy plus SLNM with or without backup lymphadenectomy. Measurements and Main Results Applying a propensity score matching algorithm we selected 180 patients having SLNM (90 SLNM vs. 90 SLNM followed by lymphadenectomy). Median follow-up time was 69 months. Overall, 10% of patients were diagnosed with positive nodes. Low volume disease was observed in 16 cases (5 micrometastasis and 11 isolated tumor cells). Patients having SLNM followed by lymphadenectomy had not a higher possibility to be diagnosed with a stage IIIC disease in comparison to SLNM alone (p=0.389). The survival analysis comparing did not show statistical differences in terms of disease-free (p=0.570, log-rank test) and overall survival (p=0.911, log-rank test) were similar between groups. No survival differences were observed also after stratification in low, intermediate and high-risk patients (p>0.20). Conclusion Our study highlighted that laparoscopic staging is safe and effective in EC. SLNM provides similar long-term oncologic outcomes than lymphadenectomy. Further evidence is warranted to assess the prognostic value of low-volume disease detected by ultra staging in patients following SLNM.