Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy

Schlappe, Brooke A.; Weaver, Amy L.; Ducie, J.A.; Eriksson, Ane Gerda Zahl; Dowdy, Sean C.; Cliby, William A.; Glaser, Gretchen; Soslow, Robert A.; Alektiar, Kaled M.; Makker, Vicky; Abu‐Rustum, Nadeem R.; Mariani, Andrea; Leitao, Mario M.

doi:10.1016/j.ygyno.2018.08.022

Cited by 66 publications

(58 citation statements)

References 28 publications

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“…Compared to pelvic and/or para-aortic lymphadenectomy, sentinel lymph node dissection was not found to be associated with either increased length of stay or readmission. Thus, given evidence that oncologic outcomes for early stage endometrial cancer are similar when comparing lymphadenectomy versus sentinel lymph node dissection, our findings provide further rationale for pursuing sentinel lymph node dissection rather than full lymphadenectomy [34]. Last, patients with prolonged length of stay after MIS for endometrial cancer had almost three times higher risk of readmission than those patients with earlier discharge in our cohort.…”

Section: Risk Factormentioning

confidence: 59%

Evaluating unplanned readmission and prolonged length of stay following minimally invasive surgery for endometrial cancer

Kohut

Earnhardt

Cuccolo

et al. 2020

Gynecologic Oncology

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Section: Risk Factormentioning

confidence: 59%

Evaluating unplanned readmission and prolonged length of stay following minimally invasive surgery for endometrial cancer

Kohut

Earnhardt

Cuccolo

et al. 2020

Gynecologic Oncology

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“…Whether aortic lymphadenectomy could have a therapeutic role is a debatable point, as well as what is the best adjuvant therapy for node-positive patients. Multicenter retrospective series have not identified differences in survival in women with endometrial cancer treated with an SLN mapping procedure or full staging lymphadenectomy 26 27. Undoubtedly having aortic nodal involvement (FIGO stage IIIC2) has a prognostic impact.…”

Section: Discussionmentioning

confidence: 99%

Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers

Martinelli

Ditto

Bogani

et al. 2020

Int J Gynecol Cancer

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ObjectiveTo report on the performance of hysteroscopic injection of tracers (indocyanine green (ICG) and technetium-99m (Tc-99m)) for sentinel lymph node (SLN) mapping in endometrial cancer.MethodsSingle-center retrospective evaluation of consecutive patients who underwent SLN mapping following hysteroscopic peritumoral injection of tracer. Detection rate (overall/bilateral/aortic) diagnostic accuracy, and oncologic outcomes were evaluated.ResultsA total of 221 procedures met the inclusion criteria. Mean patient age was 60 (range 28–84) years and mean body mass index was 26.9 (range 15–47) kg/m2 . In 164 cases (70.9%) mapping was performed laparoscopically. The overall detection rate of the technique was 94.1% (208/221 patients). Bilateral pelvic mapping was found in 62.5% of cases with at least one SLN detected and was more frequent using ICG than with Tc-99m (73.8% vs 53.3%; p<0.001). In 47.6% of cases SLNs mapped in both pelvic and aortic nodes, and in five cases (2.4%) only in the aortic area. In eight patients (3.8%) SLNs were found in aberrant (parametrial/presacral) areas. Mean number of detected SLNs was 3.7 (range 1–8). In 51.9% of cases at least one node other than SLNs was removed. Twenty-six patients (12.5%) had nodal involvement: 12 (46.2%) macrometastases, six (23.1%) micrometastases, and eight (30.7%) isolated tumor cells. In 12 cases (46.8%) the aortic area was involved. Overall, 6/221 (2.7%) patients had isolated para-aortic nodes. Three false-negative results were found, all in the Tc-99m group. All had isolated aortic metastases. Overall sensitivity was 88.5% (95% CI 71.7 to 100.0) and overall negative predictive value was 96.5% (95% CI 86.8 to 100.0). There were 10 (4.8%) recurrences: five abdominal/distant, four vaginal, and one nodal (in the aortic area following a unilateral mapping plus side-specific pelvic lymphadenectomy). Most recurrences (9/10 cases) were patients in whom a completion lymphadenectomy was performed. No deaths were reported after a mean follow-up of 47.7 months.ConclusionsHysteroscopic injection of tracers for SLN mapping in endometrial cancer is as accurate as cervical injection with a higher detection rate in the aortic area. ICG improves the bilateral detection rate. Adding lymphadenectomy to SLN mapping does not reduce the risk of relapse.

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“…The therapeutic superiority of LND over SLN mapping alone, especially in high-risk cases and those with SLN metastasis, is still highly debatable. Retrospective analyses, however, have suggested that using SLN mapping over LND does not compromise oncologic outcome in such cases [10,11]. Furthermore, SLN mapping compared with LND is associated with a much lower risk of LEL development in patients with vulvar or endometrial cancer [12,13].…”

Section: Introductionmentioning

confidence: 99%

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy

Leitao

Zhou

Gómez-Hidalgo

et al. 2020

Gynecologic Oncology

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h i g h l i g h t s SLN mapping was independently associated with significantly lower rate of patient-reported lower extremity lymphedema (LEL). Increasing BMI and use of adjuvant EBRT were associated with an increased prevalence of patient-reported LEL. SLN mapping in the surgical management of newly diagnosed endometrial cancer may spare these patients from LEL. Survival outcomes were similar between SLN mapping and comprehensive lymphadenectomy after endometrial cancer surgery.

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Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy

Abstract: Use of an SLN algorithm in deeply invasive EEC does not impair oncologic outcomes. Survival is excellent in node-negative cases, irrespective of assessment method. Adjuvant chemotherapy in node-negative patients does not appear to impact outcome.

Cited by 66 publications

References 28 publications

Evaluating unplanned readmission and prolonged length of stay following minimally invasive surgery for endometrial cancer

Evaluating unplanned readmission and prolonged length of stay following minimally invasive surgery for endometrial cancer

Sentinel lymph node mapping in endometrial cancer: performance of hysteroscopic injection of tracers

Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy

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