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Does sentinel node mapping impact morbidity and quality of life in endometrial cancer?
  1. Bruna Tirapelli Goncalves1,
  2. Ricardo Dos Reis2,
  3. Reitan Ribeiro3,
  4. Renato Moretti-Marques4,
  5. Fernanda Karoline Schamme3,
  6. Gabriela Silva Oliveira2,
  7. Audrey Tieko Tsunoda3,5,6,
  8. Vanessa Alvarenga-Bezerra4,
  9. Andre Lopes7,
  10. Caroline Batista Pinheiro Pastore7,
  11. Lillian Yuri Kumagai1,
  12. Carlos Chaves Faloppa1,
  13. Henrique Mantoan1,
  14. Levon Badiglian-Filho1,
  15. Louise De Brot8,
  16. Carlos Eduardo Mattos Cunha Andrade2 and
  17. Glauco Baiocchi1
  1. 1Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, Brazil
  2. 2Department of Gynecologic Oncology, Barretos Cancer Hospital, Barretos, Brazil
  3. 3Department of Gynecologic Oncology, Erasto Gaertner Hospital, Curitiba, Brazil
  4. 4Department of Gynecologic Oncology, Albert Einstein Hospital, Sao Paulo, Brazil
  5. 5HCor Oncology, Sao Paulo, Brazil
  6. 6PPGTS/Pontificia Universidade Catolica do Parana, Curitiba, Brazil
  7. 7Department of Gynecologic Oncology, Sao Camilo Oncologia, Sao Paulo, Brazil
  8. 8Department of Anatomic Pathology, AC Camargo Cancer Center, Sao Paulo, Brazil
  1. Correspondence to Dr Glauco Baiocchi, Department of Gynecologic Oncology, AC Camargo Cancer Center, Sao Paulo, São Paulo, Brazil; glauco.baiocchi{at}


Objectives To evaluate the prevalence of post-operative complications and quality of life (QoL) related to sentinel lymph node (SLN) biopsy vs systematic lymphadenectomy in endometrial cancer.

Methods A prospective cohort included women with early-stage endometrial carcinoma who underwent lymph node staging, grouped as follows: SLN group (sentinel lymph node only) and SLN+LND group (sentinel lymph node biopsy with addition of systematic lymphadenectomy). The patients had at least 12 months of follow-up, and QoL was assessed by European Organization for Research and Treatment of Cervical Cancer Quality of Life Questionnaire 30 (EORTC-QLQ-C30) and EORTC-QLQ-Cx24. Lymphedema was also assessed by clinical evaluation and perimetry.

Results 152 patients were included: 113 (74.3%) in the SLN group and 39 (25.7%) in the SLN+LND group. Intra-operative surgical complications occurred in 2 (1.3%) cases, and all belonged to SLN+LND group. Patients undergoing SLN+LND had higher overall complication rates than those undergoing SLN alone (33.3% vs 14.2%; p=0.011), even after adjusting for confound factors (OR=3.45, 95% CI 1.40 to 8.47; p=0.007). The SLN+LND group had longer surgical time (p=0.001) and need for admission to the intensive care unit (p=0.001). Moreover, the incidence of lymphocele was found in eight cases in the SLN+LND group (0 vs 20.5%; p<0.001). There were no differences in lymphedema rate after clinical evaluation and perimetry. However, the lymphedema score was highest when lymphedema was reported by clinical examination at 6 months (30.1 vs 7.8; p<0.001) and at 12 months (36.3 vs 6.0; p<0.001). Regarding the overall assessment of QoL, there was no difference between groups at 12 months of follow-up.

Conclusions There was a higher overall rate of complications for the group undergoing systematic lymphadenectomy, as well as higher rates of lymphocele and lymphedema according to the symptom score. No difference was found in overall QoL between SLN and SLN+LND groups.

  • Endometrial Neoplasms
  • Sentinel Lymph Node
  • Quality of Life (PRO)/Palliative Care
  • Postoperative complications
  • Lymphatic System

Data availability statement

Data are available upon reasonable request. The data and material will be available by the authors upon reasonable request.

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Data availability statement

Data are available upon reasonable request. The data and material will be available by the authors upon reasonable request.

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  • Twitter @andrelopesMD, @Levon66175314, @glaucobaiocchi

  • Contributors Study concept and design: RDR, BG, GB; data acquisition: CP, VA, GO, FS, RM-M, RDR, RR, LDB, BG, LYK, CCF, GB; quality control of data: CeEMdCA, ATT, RDR, RR, BTG, HM, CCF, GB; data analysis and interpretation: AL, RDR, BG, LYK, LB-F, LDB, GB; statistical analysis: BG, GB; manuscript preparation and editing: BG, GB; manuscript review: all authors; guarantor of the manuscript: GB.

  • Funding This study was partially sponsored by Brazilian National Research Council (CNPq) #307703/2019-3.

  • 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.