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Laparoscopic treatment of early-stage endometrial cancer: benefits of sentinel lymph node mapping and impact on lower extremity lymphedema
  1. Jvan Casarin1,
  2. Gabriella Schivardi2,
  3. Valeria Artuso1,
  4. Anna Giudici1,
  5. Tommaso Meschini1,
  6. Luigi De Vitis2,
  7. Vincenzo Granato1,
  8. Antonio Lembo1,3,
  9. Antonella Cromi1,
  10. Andrea Mariani4,
  11. Giorgio Bogani5,
  12. Francesco Multinu2 and
  13. Fabio Ghezzi1
    1. 1 Department of Obstetrics and Gynecology, University of Insubria Faculty of Medicine and Surgery, Varese, Italy
    2. 2 Department of Gynecology, European Institute of Oncology, Milan, Italy
    3. 3 Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, New York, USA
    4. 4 Gynecologic Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
    5. 5 Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, Milan, Italy
    1. Correspondence to Dr Jvan Casarin; j.casarin{at}uninsubria.it

    Abstract

    Objective 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 by type of actual nodal assessment.

    Methods An ambispective study was conducted on consecutive patients surgically treated for 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 post-operative complications were collected. Lymphedema screening was performed 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 actual surgical staging: hysterectomy+SLN (54.8%), hysterectomy+systematic pelvic lymphadenectomy (27.2%), and hysterectomy only (18%). The prevalence of lymphedema was significantly lower in the hysterectomy+SLN group compared with the hysterectomy+systematic pelvic lymphadenectomy group (21.4% vs 44.6%, p=0.003). Multivariable analysis showed a threefold increase in the risk of lymphedema for the hysterectomy+systematic pelvic lymphadenectomy group compared with the hysterectomy+SLN group: OR 3.11 (95% CI 1.47 to 6.58). No significant associations were found between lymphedema and other patient or tumor characteristics.

    Conclusion In the setting of a laparoscopic approach for early-stage endometrial cancer surgery, SLN mapping is associated with a significant reduction in lymphatic complications compared with a systematic lymph node dissection. Our findings provide additional evidence endorsing the adoption of SLN mapping during minimally invasive surgery for endometrial cancer. This technique ensures comparable diagnostic accuracy and also minimizes complications.

    • Sentinel Lymph Node
    • Endometrial Neoplasms
    • Lymphocele

    Data availability statement

    Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

    https://doi.org/10.1136/ijgc-2024-005670

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      Data availability statement

      Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. In accordance with the journal’s guidelines, we will provide our data for independent analysis by a selected team by the Editorial Team for the purposes of additional data analysis or for the reproducibility of this study in other centers if such is requested.

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      Footnotes

      • X @Fmultinu

      • Contributors Conception and design of the study: JC, GS, AC, AM, GB, FM, FG. Data collection: GS, VA, AG, TM, LDV, VG, AL. Data analysis and interpretation: JC, GS, VA, AG, TM, VG, AC, AM, GB, FM, FG. Responsible surgeons: JC, FG. Statistical analysis: JC, AC. Manuscript preparation: JC, GS, VA, AG, TM, LDV, VG, AL, AC, AM, GB, FM, FG. Patient recruitment: JC, GS, VA, AG, TM, LDV, VG, AL, FG. Guarantor: JC.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • 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.