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Surgical and oncological outcomes of sentinel lymph node sampling in elderly patients with intermediate to high-risk endometrial carcinoma
  1. Emad Matanes1,2,
  2. Neta Eisenberg3,
  3. Cristina Mitric1,
  4. Amber Yasmeen2,
  5. Sara Ismail1,
  6. Oded Raban1,2,
  7. Tal Cantor1,
  8. David Knigin2,
  9. Susie Lau1,
  10. Shannon Salvador1,
  11. Walter Gotlieb1,2 and
  12. Liron Kogan4
  1. 1Division of Gynecologic Oncology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
  2. 2Lady Davis Institute for Medical Research, Montreal, Quebec, Canada
  3. 3Yitzhak Shamir Medical Center Assaf Harofeh, Zerifin, Center, Israel
  4. 4Department of Obstetrics and Gynecology, Hadassah Medical Center, Jerusalem, Israel
  1. Correspondence to Dr Emad Matanes, Jewish General Hospital, Montreal, QC H3T 1E2, Canada; emad.matanes{at}


Objective We aimed to evaluate the surgical and oncological outcomes of elderly patients with intermediate to high-risk endometrial cancer undergoing staging with sentinel lymph node (SLN) sampling and pelvic lymphadenectomy.

Methods We conducted a retrospective study of elderly (>65-year-old) patients diagnosed with endometrial cancer between December 2007 and August 2017. These patients had been treated at a single center in Montreal, Canada. We compared the surgical and oncological outcomes of three cohorts undergoing surgical staging in non-overlapping eras: 1) lymphadenectomy, 2) lymphadenectomy and SLN sampling, 3) SLN sampling alone. Using life tables, Kaplan-Meier survival curves and log-rank tests, we analyzed 2-year progression-free survival, overall survival, and disease-specific survival.

Results Our study included 278 patients with a median age of 73 years (range; 65–91): 84 (30.2%) underwent lymphadenectomy, 120 (43.2%) underwent SLN sampling with lymphadenectomy, and 74 (26.6%) had SLN sampling alone. The SLN sampling alone group had shorter operative times with a median duration of 199 minutes (range, 75–393) compared with 231 (range, 125–403) and 229 (range, 151–440) minutes in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts; respectively (p<0.001). The SLN sampling alone group also had lower estimated blood loss with a median loss of 20 mL (range, 5–150) vs 25 mL (range, 5–800) and 40 mL (range, 5–400) in the SLN sampling with lymphadenectomy and lymphadenectomy cohorts, respectively (p=0.002). The 2 year overall survival and progression-free survival were not significantly different between the three groups (p=0.45, p=0.51, respectively). On multivariable analysis after adjusting for age, American Society of Anesthesiologists (ASA) score, stage, grade, and lymphovascular space invasion, adding SLN sampling was associated with better overall survival, (HR 0.2, CI [0.1 to 0.6], p=0.006) and progression-free survival (HR 0.5, CI [0.1 to 1.0], p=0.05).

Conclusion Sentinel lymph node-based surgical staging is feasible and associated with better surgical outcomes and comparable oncological outcomes in elderly patients with intermediate and high-risk endometrial cancer.

  • Sentinel Lymph Node

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors EM was responsible for the study design, statistical analysis, tables and figures, introduction, results interpretation, methods, discussion and he is the guarantor. NE performed the statistical analysis and manuscript editing. CM, SI, TC, AY, DK, OR supported on data collection and editing the manuscript. SS, SL supported the data collection and interpreted results. WG participated in the study design, results interpretation, manuscript editing and the discussion section. LK participated in the study design, abstract, introduction, results interpretation, methods, and the discussion.

  • Funding This study was supported by grants from the Israel Cancer Research Fund, the Azrieli foundation, the Gloria’s Girls Fund, the Susan and Jonathan Wener Fund, and the Anne-Marie and Mitch Garber Fund.

  • 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.