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

Abstract

ObjectiveTo evaluate the utility of sentinel lymph node mapping (SLN) in endometrial cancer (EC) patients in comparison with lymphadenectomy (LND).MethodsComprehensive search was performed in MEDLINE, EMBASE, CENTRAL, OVID, Web of science databases, and three clinical trials registration websites, from the database inception to September 2020. The primary outcomes covered operative outcomes, nodal assessment, and oncological outcomes. Software Revman 5.3 was used. Trial sequential analysis (TSA) and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) were performed.ResultsOverall, 5,820 EC patients from 15 studies were pooled in the meta-analysis: SLN group (N = 2,152, 37.0%), LND group (N = 3,668, 63.0%). In meta-analysis of blood loss, SLN offered advantage over LND in reducing operation bleeding (I2 = 74%, P<0.01). Z-curve of blood loss crossed trial sequential monitoring boundaries though did not reach TSA sample size. There was no difference between SLN and LND in intra-operative complications (I2 = 7%, P = 0.12). SLN was superior to LND in detecting positive pelvic nodes (P-LN) (I2 = 36%, P<0.001), even in high risk patients (I2 = 36%, P = 0.001). While no difference was observed in detection of positive para-aortic nodes (PA-LN) (I2 = 47%, P = 0.76), even in high risk patients (I2 = 62%, P = 0.34). Analysis showed no difference between two groups in the number of resected pelvic nodes (I2 = 99%, P = 0.26). SLN was not associated with a statistically significant overall survival (I2 = 79%, P = 0.94). There was no difference in progression-free survival between SLN and LND (I2 = 52%, P = 0.31). No difference was observed in recurrence. Based on the GRADE assessment, we considered the quality of current evidence to be moderate for P-LN biopsy, low for items like blood loss, PA-LN positive.ConclusionThe present meta-analysis underlines that SLN is capable of reducing blood loss during operation in regardless of surgical approach with firm evidence from TSA. SLN mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high risk patients with conclusive evidence from TSA. Utility of SLN yields no survival detriment in EC patients.

Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review

“…Mayo Clinic analyzed 378 patients and found that SLN may significantly decrease the risk of lymphedema compared with LAD (26.0% vs. 49.4%, p<0.001) (96). Several meta-analyses included current retrospective and prospective studies presented similar conclusions, which was SLN resulted in less blood loss, lymphedema, and other complications, meanwhile, SLN detected more pelvic metastasis (97,98). These results may indicate that SLNM is able to minimize the surgical risk and reduce the complications with no survival detriment in EC, which is of great value to improve the quality of life.…”

Cancer of the corpus uteri: 2021 update

“…Additionally, cervical injection increases the bilateral sentinel lymph node detection rate but decreases the para‐aortic detection rate compared with alternative injection techniques. A meta‐analysis pooling approximately 6000 patients suggests that sentinel lymph node mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high‐risk patients 76 . Since sentinel lymph node mapping can safely replace lymphadenectomy in the staging of endometrial cancer, it is becoming the preferred method for lymph node sampling, even in high‐risk cancer.…”

“…A meta‐analysis pooling approximately 6000 patients suggests that sentinel lymph node mapping is more targeted for less node dissection and more detection of positive lymph nodes even in high‐risk patients. 76 Since sentinel lymph node mapping can safely replace lymphadenectomy in the staging of endometrial cancer, it is becoming the preferred method for lymph node sampling, even in high‐risk cancer. However, side‐specific systematic lymphadenectomy should be performed in high intermediate‐risk/high‐risk patients if the sentinel lymph node is not detected on either pelvic side.…”

A novel deep neural network based marine predator model for effective classification of big data from social Internet of Things

“…During reduction process, the input dataset is provided to the MapReduce data thereby splitting into independent data by employing map process. 38 The output obtained in the map task is provided as an input of the map reduce task. The map functions implement the allocation process of every data sample to the neighboring focus and at the same time, the map reduce task accomplishes the updating of new centers.…”