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PR004/#631  Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema
  1. Anna Giudici1,
  2. Tommaso Meschini1,
  3. Gabriella Schivardi2,
  4. Daniela Costantini1,
  5. Valeria Artuso1,
  6. Giorgio Bogani3,
  7. Francesco Multinu2,
  8. Fabio Ghezzi1 and
  9. Jvan Casarin1
  1. 1University of Insubria, Obstetrics and Gynecology, Varese, Italy
  2. 2European Institute of Oncology, Gynecology, Milano, Italy
  3. 3Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milano, Italy

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.

Abstract 1 PR004/#631 Figure 1

Rates of reported significant lower extremity lymphedema (LEL). A: rates of reported significant LEL in the overall study population. B: rates of LEL by actual surgical strategy: hysterectomy only (HYST). hysterectomy + sentinel lymph node (SLN); hysterectomy + systematic pelvic lymphadenectomy (LND)

Abstract 1 PR004/#631 Table 1

Predictors of lower extremity lymphedema

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