Sentinel Lymph Node Mapping Versus Systemic Lymphadenectomy in High-Risk Endometrial Cancer Patients: A Meta-Analysis...

To compare the oncologic outcomes of sentinel lymph node mapping (SLNM) and systemic lymphadenectomy (LND) in patients with high-risk endometrial cancer (EC) using a meta-analysis.

PubMed, Embase, and the Cochrane Library were systematically searched from inception to November 2024 using terms related to "sentinel lymph node," "lymphadenectomy," and "endometrial cancer," with no language or publication date restrictions.

Retrospective studies comparing SLNM and LND in high-risk or high-intermediate-risk EC were included. Thirteen studies met eligibility criteria, comprising 1,405 patients in the SLNM group and 7,606 in the LND group.

Overall, 13 retrospective studies were included (SLNM, 1,405 patients; LND, 7,606 patients). No significant differences in recurrence (hazard ratio (HR) = 0.89; 95% confidence interval (CI): 0.74-1.07; I² = 0; p < 1.00) and mortality (HR = 0.72; 95% CI: 0.56-1.01; I² = 63.3; p = .001) were observed between the 2 groups. Subgroup analysis according to histology with mortality data showed no increase in mortality with carcinosarcoma, serous carcinoma, and clear cell carcinoma (HR = 0.51; 95% CI: 0.38-0.67; I² = 0.0; p = .001). Further subgroup analysis according to stage, histology, and risk groups supported the overall findings, showing no significant differences between SLNM and LND.

SLNM alone for high-risk EC did not increase recurrence or mortality when compared to LND. Although SLNM offers several advantages, such as reduced complications and improved quality of life, further prospective studies are needed to confirm these findings and refine SLNM guidelines in high-risk EC.