Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema

Jvan Casarin ¹, Gabriella Schivardi ², Valeria Artuso ³

⁰Department of Obstetrics and Gynecology, University of Insubria Faculty of Medicine and Surgery, Varese, Italy j.casarin@uninsubria.it.

International Journal of Gynecological Cancer : Official Journal of the International Gynecological Cancer Society +

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September 23, 2024

View abstract on PubMed

Summary

Sentinel lymph node (SLN) mapping significantly reduces lymphedema risk in early-stage endometrial cancer surgery compared to systematic lymph node dissection. This minimally invasive approach offers comparable accuracy with fewer complications.

Area Of Science

Gynecologic Oncology
Minimally Invasive Surgery
Cancer Staging

Background

Laparoscopic surgery is increasingly used for early-stage endometrial cancer.
Sentinel lymph node (SLN) mapping is a technique to identify key lymph nodes for metastasis.
Lymphatic complications, such as lymphedema, are potential morbidities of lymph node dissection.

Purpose Of The Study

To evaluate lymphatic-specific morbidity, specifically lower extremity lymphedema.
To compare lymphedema rates based on different nodal assessment methods in laparoscopic endometrial cancer surgery.

Main Methods

An ambispective study included 239 patients with early-stage endometrial cancer undergoing laparoscopic staging.
Patients were grouped by nodal assessment: hysterectomy+SLN, hysterectomy+systematic pelvic lymphadenectomy, or hysterectomy only.
Lymphedema was assessed via a validated questionnaire post-operatively.

Main Results

Lymphedema prevalence was 21.4% in the SLN group versus 44.6% in the systematic lymphadenectomy group (p=0.003).
Systematic pelvic lymphadenectomy was associated with a threefold increased risk of lymphedema (OR 3.11).
No significant associations between lymphedema and other patient or tumor characteristics were found.

Conclusions

Sentinel lymph node (SLN) mapping significantly reduces lymphedema compared to systematic lymph node dissection in laparoscopic endometrial cancer surgery.
SLN mapping provides a safe and effective alternative, minimizing complications while maintaining diagnostic accuracy.
These findings support the adoption of SLN mapping in minimally invasive endometrial cancer staging.

Keywords:

Endometrial Neoplasms Lymphocele Sentinel Lymph Node