Article Text
Abstract
Introduction To evaluate the lymphatic-specific morbidity, specifically lower extremity lymphedema, associated with laparoscopic management of early-stage endometrial cancer using the sentinel lymph node (SLN) algorithm.
Methods A prospective study was conducted on consecutive patients with apparent early-stage endometrial cancer, who underwent laparoscopic staging according to the National Comprehensive Cancer Network SLN algorithm at a single institution from January 2020 to August 2023. Data on patient characteristics, surgical details, and postoperative complications were collected. Lymphedema was determined using a validated questionnaire.
Results A total of 239 patients were analyzed, with a questionnaire response rate of 85.4%. The study population was grouped based on the actual surgical staging received: hysterectomy + SLN (54.8%), hysterectomy + systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). Lymphedema prevalence was significantly lower in the hysterectomy + SLN group compared to the hysterectomy + systematic pelvic lymphadenectomy group (21.4% vs. 44.6%, p=0.003) (figure 1). Multivariable analysis revealed a threefold increase in the risk of lymphedema for the hysterectomy+ systematic pelvic lymphadenectomy group (compared to hysterectomy + SLN): Odds Ratio 3.11, 95%CI 1.47-6.58 (table 1). No significant associations were found between lymphedema and other patient’s or tumor’s characteristics.
Conclusion/Implications In the setting of a laparoscopic approach for early-stage endometrial cancer surgery, SLN is associated with a significant reduction in lymphatic complications when compared to a systematic lymph node dissection. Our findings provide additional evidence endorsing the adoption of SLN mapping during laparoscopic surgery for endometrial cancer. This technique ensures comparable diagnostic accuracy and minimizes complications.