The Futility of Systematic Lymphadenectomy in Early-Stage Low-grade Endometrial Cancer

Lymphadenectomy is considered an integral part of comprehensive surgical staging of endometrial cancer but debate on the value of lymphadenectomy continues in early-stage endometrial cancer. The aim of our study was to determine the number of node positive patients in clinically early-stage low-grade (G1-G2) endometrioid endometrial cancer. We retro-prospectively analyzed the medical records of 155 women with endometrial pathology coming to the BLK cancer center between January 2015 and December 2017 and studied 60 patients of FIGO grade 1-2 endometrioid endometrial cancer confined to the uterus to determine the nodal positivity. Out of total 60 cases, 2 (3.3%) patients had positive nodes indicating the very low incidence of nodal positivity in clinically uterus confined low-grade endometrioid tumors. Both pelvic and para-aortic lymph nodes were positive in 1 patient. Skip metastases with para-aortic nodal positivity only while pelvic lymph nodes being negative were found in 1 (1.6%) patient. The necessity of comprehensive lymphadenectomy in endometrial cancer remains controversial. Sentinel node mapping can be a reasonably good alternative to strike a balance between systematic lymphadenectomy and no dissection at all in low and intermediate risk endometrial cancer.