Sentinel lymph node biopsy compared to no nodal assessment in endometrial cancer: a systematic review

Lymph node dissection has been a component of surgical staging for endometrial cancer, with more recent change to sentinel lymph node biopsy as standard of care. However, comparisons of any lymph node assessment with no nodal assessment is limited. We conducted a systematic review of literature published between June 2015 and July 5, 2025, searching Medline and Embase. Eligible studies compared sentinel lymph node biopsy to no nodal assessment and reported on: (1) peri-operative outcomes (2) oncologic outcomes (3) adjuvant treatment (4) patient-reported outcomes (5) lymphoedema outcomes, or (6) cost. Peer-reviewed publications in English, reporting on adult women who underwent sentinel lymph node biopsy or no nodal assessment for endometrial cancer were included. Studies reporting fewer than 10 patients, and reviews, commentaries, editorials, letters, protocol papers, conference proceedings, guidelines, and clinical trial registrations were excluded. Screening was performed in Covidence by 2 independent reviewers. Eight observational studies were eligible for inclusion. Considerable heterogeneity existed in study design and reporting. Evidence was too inconsistent to detect meaningful differences in peri-operative outcomes (blood loss, length of stay, intra-operative complications, conversion to laparotomy) or oncologic outcomes (recurrence, overall survival). Adjuvant treatment findings varied-1 study found no difference in adjuvant treatment between sentinel lymph node biopsy compared to no nodal assessment; another study found that patients who did not have nodal assessment were less likely to receive adjuvant treatment. Lymphoedema outcomes were inconsistent-2 studies suggested lower rates with sentinel lymph node biopsy, while another found no difference. Cost data were limited; 1 study reported no nodal assessment as attracting the lowest charges. There were no studies comparing patient-reported outcomes between sentinel lymph node biopsy and no nodal assessment. Comparative evidence between sentinel lymph node and no nodal assessment in endometrial cancer remains limited. Gaps are greatest in patient-reported outcomes, lymphoedema, and cost outcomes.