Introduction The paradigm shift from pelvic lymphadenectomy (PLD) to sentinel lymph node biopsy (SLNB) in managing early endometrial cancer (EC) has significantly reduced morbidity. However, the limited accessibility of SLNB in Low- or Middle-Income Country (LMIC) hospitals due to cost constraints has resulted in poor uptake of PLD and heterogenous management approach in low-risk and presumed early-stage EC. This retrospective analysis aims to assess the potential undertreatment of presumed stage 1 EC when compared to data from the University Hospital of Wales (UHW) where SLNB is the standard approach.

Methods Cases were identified from Surgical electronic database and Welsh clinical-portal using terms ‘endometrial cancer’, ‘sentinel lymph node biopsy’ between 1/1/2020 – 31/12/2023. Analysed using Microsoft Excel 2019 MSO (16.0.10402.20023)

Results A total of 510 surgeries for endometrial cancer were performed at UHW between 2020 and 2023, with 79.8% (407/510) of cases presumed to be at stage 1 from preoperative imaging. Pelvic lymphadenectomy was conducted in 47.9% (195/407) of these cases, with 92.3% (180/195) using the SLNB technique. Subsequent lymph node ultra-staging analysis revealed that 17.2% (31/180) of cases were positive for metastasis.

Conclusion/Implications The findings indicate that 17% of presumed stage 1 EC were upstaged to stage 3 postoperatively. Adjuvant treatment for stage 1 is not standard, and these would have been overlooked and potentially undertreated if PLD or SLNB were not performed. This could increase the risk of recurrence in the future, emphasizing the necessity for broader access to SLNB in LMIC hospitals despite the additional costs, to optimize the management of early-stage EC cases.