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Overall survival after surgical staging by lymph node dissection versus sentinel lymph node biopsy in endometrial cancer: a national cancer database study
  1. Simone Garzon1,2,
  2. Andrea Mariani2,
  3. Courtney N Day3,
  4. Elizabeth B Habermann3,
  5. Carrie Langstraat2,
  6. Gretchen Glaser2,
  7. Amanika Kumar2,
  8. Jvan Casarin2,4,
  9. Stefano Uccella5,
  10. Fabio Ghezzi1 and
  11. Alyssa Larish2
  1. 1Department of Obstetrics and Gynecology, ‘Filippo Del Ponte’ Hospital, University of Insubria, Varese, Italy
  2. 2Department Obstetrics and Gynecology, Mayo Clinic Rochester, Rochester, Minnesota, USA
  3. 3Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
  4. 4Department of Obstetrics and Gynecology, University of Insubria Faculty of Medicine and Surgery, Varese, Italy
  5. 5Department of Obstetrics and Gynecology, University of Verona, Verona, Italy
  1. Correspondence to Dr Alyssa Larish, Department of Gynecology and Obstetrics, Mayo Clinic Rochester, Rochester, MN 55905, USA; larish.alyssa{at}


Objective Substituting lymphadenectomy with sentinel lymph node biopsy for staging purposes in endometrial cancer has raised concerns about incomplete nodal resection and detrimental oncological outcomes. Therefore, this study aimed to investigate the association between the type of lymph node assessment and overall survival in endometrial cancer accounting for node status and histology.

Methods Women with stage I–III endometrial cancer who underwent hysterectomy and lymph node assessment from January 2012 to December 2015 were identified in the National Cancer Database. Patients who underwent neoadjuvant therapy, had previous cancer, and whose follow-up was less than 90 days were excluded. Multivariable Cox proportional hazards regression analyses were performed to assess factors associated with overall survival.

Results Of 68 614 patients, 64 796 (94.4%) underwent lymphadenectomy, 1777 (2.6%) underwent sentinel node biopsy only, and 2041 (3.0%) underwent both procedures. On multivariable analysis, neither sentinel lymph node biopsy alone nor sentinel node biopsy followed by lymphadenectomy was associated with significantly different overall survival compared with lymphadenectomy alone (HR 0.92, 95% CI 0.73 to 1.17, and HR 0.91, 95% CI 0.77 to 1.08, respectively). When stratified by lymph node status, sentinel node biopsy alone or followed by lymphadenectomy was not associated with different overall survival, both in patients with negative (HR 0.95, 95% CI 0.73 to 1.24, and HR 1.04, 95% CI 0.85 to 1.27, respectively) or positive (HR 0.91, 95% CI 0.54 to 1.52, and HR 0.77, 95% CI 0.57 to 1.04, respectively) lymph nodes. These findings held true when sentinel node biopsy alone and sentinel node biopsy plus lymphadenectomy groups were merged, and on stratification by histotype (type one vs type 2) or inclusion of only complete lymphadenectomy (at least 10 pelvic nodes and at least one para-aortic node removed). In all analyses, age, Charlson-Deyo score, black race, AJCC pathological T stage, grade, lymphovascular invasion, brachytherapy, and adjuvant chemotherapy were independently associated with overall survival.

Discussion No difference in overall survival was found in patients with endometrial cancer who underwent sentinel node biopsy alone, sentinel node biopsy followed by lymphadenectomy, or lymphadenectomy alone. This observation remained regardless of node status, histotype, and lymphadenectomy extent.

  • uterine cancer

Data availability statement

Data are available in a public, open access repository. Used data are available at no cost to members of the American College of Surgeons through an application process.

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Data availability statement

Data are available in a public, open access repository. Used data are available at no cost to members of the American College of Surgeons through an application process.

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  • Contributors Conception and design of the study: SG, AM, and AL. Data analysis and interpretation: CND, EBH, SG, AM, AL, CL, GG, AK, JC, SU, and FG. Writing, review, and editing the manuscript: all authors. Guarantor accepting full responsibility for the work and conduct of the study, access to study data, and controlled the decision to publish: AL

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.