Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: surgical outcomes and hospital charges

Abstract

IntroductionThe purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a sentinel lymph node (SLN) mapping algorithm in endometrial cancer.MethodsAll patients with clinical stage I endometrial cancer were identified pre- (2012) and post- (2017) implementation of the SLN algorithm. Clinical data were summarized and compared between groups. Total hospital charges incurred on the day of surgery were extracted from the hospital financial system for each patient and all charges were adjusted to 2017 US dollars.ResultsA total of 203 patients were included: 71 patients in 2012 and 130 patients in 2017. There was no difference in median age, body mass index, or stage. In 2012, 35/71 patients (49.3%) underwent a lymphadenectomy. In 2017, SLN mapping was attempted in 120/130 patients (92.3%) and at least one SLN was identified in 110/120 (91.7%). Median estimated blood loss was similar between groups (100 mL vs 75 mL, p=0.081). There was a significant decrease in both median operative time (210 vs 171 min, p=0.007) and utilization of intraoperative frozen section (63.4% vs 14.6%, p<0.0001). No significant differences were noted in intraoperative (p=1.00) or 30 day postoperative complication rates (p=0.30). The median total hospital charges decreased by 2.73% in 2017 as compared with 2012 (p=0.96).DiscussionImplementation of an SLN mapping algorithm for high- and low-risk endometrial cancer resulted in a decrease in both operative time and intraoperative frozen section utilization with no change in surgical morbidity. While hospital charges did not significantly change, further studies are warranted to assess the true cost of SLN mapping.

Operative and Oncological Outcomes Comparing Sentinel Node Mapping and Systematic Lymphadenectomy in Endometrial Cancer Staging: Meta-Analysis With Trial Sequential Analysis

“…A total of 2,048 articles were screened through the search strategy, and 21 articles were included after full text reading. Four were excluded for low quality assessment score (<6) ( 14 – 17 ), two were excluded for patients overlapping ( 18 , 19 ), thus leaving 15 articles eligible for final analysis ( 7 , 20 – 33 ) ( Figure 1 ). Characteristics of the 15 studies are summarized in Supplement Table S1 .…”

“…Recent studies focusing on operation-related outcomes indicated that SLN procedure could reduce operative time of minimal invasive surgery and laparotomy ( 23 , 25 , 26 , 28 , 30 , 33 ). Stewart et al ( 33 ) observed significant decrease in operative time (210 vs 170 min, P = 0.007) taking account of the surgery approach.…”

“…Recent studies focusing on operation-related outcomes indicated that SLN procedure could reduce operative time of minimal invasive surgery and laparotomy ( 23 , 25 , 26 , 28 , 30 , 33 ). Stewart et al ( 33 ) observed significant decrease in operative time (210 vs 170 min, P = 0.007) taking account of the surgery approach. And Valerio G. et al ( 47 ) discussed robotic surgery in elderly gynecological cancer patients and demonstrated that minimally invasive could considered for older patients (even over 75 years old); and this illustrated SLN procedure during minimal invasive surgery could benefit patients more, especially these over 75 years old.…”

“…In terms of complications, more evidence is needed for supporting intra- and post-operation complications declining. Accordion Severity Grading System and Clavien-Dindo scale are used to assess post- operation complications; two studies by Accordion Severity Grading System ( 30 , 33 ) and two by Clavien-Dindo scale ( 26 , 28 ) indicated SLN group occurred less post-operation complications. A retrospective study reported lower-limb lymphedema could only been seen in LND group ( 25 ).…”

Uterine Cancer Normogram to Predict Lymph Node Metastasis: Comparison to the Mayo Algorithm and an External Vali ation of a Model in a North American Population

“…Documentation of node metastasis can effect recommendations for adjuvant therapies. There have also been concerns of clinical sequela and cost effectiveness from LND, should it be performed [10][11][12].…”