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Updated: Jul 27, 2025
Sentinel Lymph Node Mapping and Biopsy for Endometrial Cancer at Early Stage with Laparoscopy
Published on: August 19, 2021
Efficacy and prognosis of robotic surgery with sentinel node navigation surgery in endometrial cancer
Shinichi Togami1, Mika Fukuda1, Mika Mizuno1
1Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
Objective:
This study aimed to validate the surgical and oncologic outcomes of robotic surgery with sentinel node navigation surgery (SNNS) in endometrial cancer.
Methods:
This study included 130 patients with endometrial cancer, who underwent robotic surgery, including hysterectomy, bilateral salpingo-oophorectomy, and pelvic SNNS at the Department of Obstetrics and Gynecology of Kagoshima University Hospital. Pelvic sentinel lymph nodes (SLNs) were identified using the uterine cervix 99m Technetium-labeled phytate and indocyanine green injections. Surgery-related and survival outcomes were also evaluated.
Results:
The median operative and console times and volume of blood loss were 204 (range: 101-555) minutes, 152 (range: 70-453) minutes, and 20 (range: 2-620) mL, respectively. The bilateral and unilateral pelvic SLN detection rates were 90.0% (117/130) and 5.4% (7/130), respectively, and the identification rate (the rate at which at least one SLN could be identified on either side) was 95% (124/130). Lower extremity lymphedema occurred in only 1 patient (0.8%), and no pelvic lymphocele occurred. Recurrence occurred in 3 patients (2.3%), and the recurrence site was the abdominal cavity, with dissemination in 2 patients and vaginal stump in one. The 3-year recurrence-free survival and 3-year overall survival rates were 97.1% and 98.9%, respectively.
Conclusion:
Robotic surgery with SNNS for endometrial cancer showed a high SLN identification rate, low occurrence rates of lower extremity lymphedema and pelvic lymphocele, and excellent oncologic outcomes.
Insights
Robotic surgery combined with sentinel lymph node navigation surgery (SNNS) offers high detection rates and excellent oncologic outcomes for endometrial cancer patients, with minimal side effects.
Area of Science:
- Gynecologic Oncology
- Minimally Invasive Surgery
- Surgical Pathology
Background:
- Endometrial cancer treatment often involves surgical staging to assess lymph node involvement.
- Sentinel lymph node biopsy (SLNB) is a crucial component of staging, aiming to reduce morbidity associated with full lymphadenectomy.
- Robotic surgery offers potential advantages in precision and visualization for gynecologic procedures.
Purpose of the Study:
- To validate the surgical and oncologic outcomes of robotic surgery combined with sentinel node navigation surgery (SNNS) in patients with endometrial cancer.
- To assess the safety and efficacy of this combined surgical approach.
Main Methods:
- A cohort of 130 endometrial cancer patients underwent robotic surgery, including hysterectomy, bilateral salpingo-oophorectomy, and pelvic SNNS.
- Pelvic sentinel lymph nodes (SLNs) were identified using 99mTechnetium-labeled phytate and indocyanine green injections.
- Surgical parameters, SLN detection rates, complication rates, and survival outcomes were evaluated.
Main Results:
- The overall SLN identification rate was 95% (124/130).
- Low rates of complications were observed: 0.8% for lower extremity lymphedema and 0% for pelvic lymphocele.
- Excellent oncologic outcomes were achieved, with a 3-year recurrence-free survival of 97.1% and 3-year overall survival of 98.9%.
Conclusions:
- Robotic surgery with SNNS demonstrates a high SLN identification rate in endometrial cancer.
- This approach is associated with a low incidence of lymphedema and pelvic lymphocele.
- The combination of robotic surgery and SNNS yields favorable oncologic outcomes for endometrial cancer patients.
