From systematic lymphadenectomy to sentinel lymph node mapping: a review on transitions and current practices in endometrial cancer staging

Abstract

Introduction: transitions in endometrial cancer stagingEndometrial cancer (EC) are a diverse group of neoplasms with a varying degree of aggressiveness, especially in early stages. An appreciable number of patients (14-22%) with stage I cancers have disease outside of the uterus (lymph node metastasis, adnexal disease, intraperitoneal spread and/ or malignant cells in peritoneal washings), thereof, 11% had pelvic (9%) and/or paraaortic (6%) nodal metastases (1).Nodal status is the strongest predictive factor of survival and is essential for tailoring adjuvant treatment to the risk of recurrence. As nodal status and therefore true extent of disease can only be reliably assessed by surgical staging, the International Federation of Gynecology and

Current Approaches to the Management of Patients with Endometrial Cancer

“…LS is associated with a shorter hospital stay, enhanced recovery, and equal-to-laparotomy detection rates for overall disease at advanced stages. Fewer postoperative complications, such as blood loss, need for blood transfusion, wound complication, or need for ICU admission were also noted [ 51 , 54 , 55 ]. Furthermore, LS was shown to be more cost effective, especially in patients with higher BMI [ 54 ].…”

“…Furthermore, LS was shown to be more cost effective, especially in patients with higher BMI [ 54 ]. Despite longer operation times, LS was not accompanied by an increase in intraoperative injuries [ 55 ]. However, it is important to mention that the LAP2 trial enrolled patients with stage I to IIA EC, while the LACE trial included patients with stage I EC.…”

“…Historically, surgical staging of EC has included complete pelvic and para-aortic lymphadenectomy [ 1 ], with the upper border at the left renal vein. As mentioned before, the nodal factor is essential in staging and provides important prognostic information [ 69 ], thus determining the need for adjuvant therapy [ 55 ], as well as the recurrence risk [ 70 ].…”

“…Nevertheless, full lymphadenectomy is associated with a number of adverse effects and high surgical morbidity [ 55 ]. Lymphedema, formation of lymphocysts, injury of blood vessels and pain and numbness from the lower abdomen to the genitalia and the inner thigh due to genitofemoral nerve damage are among the most common adverse effects.…”

“…Hematoxylin-eosin stain is used for SLN pathological analysis. In negative results, ultrastaging is recommended, which consists of deep serial sections and cytokeratin immunohistochemical stain [ 8 , 55 ].…”