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Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: surgical outcomes and hospital charges
  1. Katherine I Stewart1,
  2. Jarrod S Eska2,
  3. Ross F Harrison1,
  4. Rudy Suidan1,
  5. Ann Abraham1,
  6. Gary B Chisholm1,
  7. Larissa A Meyer1,
  8. Shannon N Westin1,
  9. Nicole D Fleming1,
  10. Michael Frumovitz1,
  11. Thomas A Aloia2 and
  12. Pamela T Soliman1
  1. 1 Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  2. 2 Institute for Cancer Care Innovation, University of Texas MD Anderson Cancer Center, Houston, Texas, USA
  1. Correspondence to Dr Pamela T Soliman, Gynecologic Oncology and Reproductive Medicine, University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA; psoliman{at}


Introduction The purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a sentinel lymph node (SLN) mapping algorithm in endometrial cancer.

Methods All patients with clinical stage I endometrial cancer were identified pre- (2012) and post- (2017) implementation of the SLN algorithm. Clinical data were summarized and compared between groups. Total hospital charges incurred on the day of surgery were extracted from the hospital financial system for each patient and all charges were adjusted to 2017 US dollars.

Results A total of 203 patients were included: 71 patients in 2012 and 130 patients in 2017. There was no difference in median age, body mass index, or stage. In 2012, 35/71 patients (49.3%) underwent a lymphadenectomy. In 2017, SLN mapping was attempted in 120/130 patients (92.3%) and at least one SLN was identified in 110/120 (91.7%). Median estimated blood loss was similar between groups (100 mL vs 75 mL, p=0.081). There was a significant decrease in both median operative time (210 vs 171 min, p=0.007) and utilization of intraoperative frozen section (63.4% vs 14.6%, p<0.0001). No significant differences were noted in intraoperative (p=1.00) or 30 day postoperative complication rates (p=0.30). The median total hospital charges decreased by 2.73% in 2017 as compared with 2012 (p=0.96).

Discussion Implementation of an SLN mapping algorithm for high- and low-risk endometrial cancer resulted in a decrease in both operative time and intraoperative frozen section utilization with no change in surgical morbidity. While hospital charges did not significantly change, further studies are warranted to assess the true cost of SLN mapping.

  • endometrial neoplasms
  • sentinel lymph node
  • lymph nodes
  • uterine neoplasms

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  • Editor's note This paper will feature in a special issue on sentinel lymph node mapping in 2020.

  • Twitter @kikardstewart, @Shannon.Westin, @nicoleflemingmd, @frumovitz, @PamSolimanMD

  • Contributors All authors provided substantial contributions to the conception, design, analysis, and manuscript preparation. All authors approved the final manuscript and agree to be accountable for all aspects of the work.

  • Funding This research was supported in part by the NIH T32 Training Grant for Gynecologic Oncologists (T32CA101642), Cancer Center Support Grant (NCI Grant P30 CA016672), NCI SPORE in Uterine Cancer (2P50 CA098258-06), and Andrew Sabin Family Fellowship (NCI K07-CA201013).

  • Competing interests LAM reports research support from AstraZeneca, outside the submitted work. SW reports grants from the NIH during the conduct of the study; personal fees and other from AstraZeneca, personal fees and other from Clovis, personal fees and other from Tesaro, personal fees and other from Roche/Genentech, other from Cotinga Pharmaceuticals, personal fees from Merck, personal fees from Pfizer, other from Novartis all outside the submitted work. MF reports grants and personal fees from Novadaq/Stryker, grants from Navidea, personal fees from Johnson and Johnson, personal fees from Genetech, personal fees from Ipsen all outside the submitted work. PS reports grants from Novartis, personal fees from Clovis Oncology all outside the submitted work.

  • Patient consent for publication Not required.

  • Ethics approval The University of Texas MD Anderson Institutional Review Board, Protocol DR10-0987.

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

  • Data availability statement Data are available upon reasonable request.