The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer

Year 2022, Volume: 39 Issue: 2, 438 - 442, 18.03.2022

Nedim Tokgozoglu Orhan Sahın , Tolga Taşçı , Nur Dokuzeylül Güngör

Abstract

Objective: This study aimed to find out whether sentinel algorithm can be sufficient in clinically
uterine confined intermediate-high risk endometrial cancer.
Methods: Detailed pathology characteristics and follow-up records of the 70 intermediate-high risk
endometrial cancer patients were identified. Outcomes of patients who are performed sentinel
algorithm and sentinel mapping followed by systematic pelvic and paraaortic lymph node dissection
were compared. All patients who had obvious extrauterine disease in preoperative and
intraoperative evaluation were excluded. Sentinel mapping is performed with methilene blue and
cervical injection.
Results: 66 patients were identified [sentinel algorithm group, 25; Paraaortic lymph node dissection
group, 45]. Paraaortic lymph node dissection group had more high grade patients (p=0,02 ). The
mean number of lymph nodes harvested was 11,3 and 36,9, respectively, in sentinel algorithm group
and paraaortic lymph node dissection group(p<0,001) and there was more lymph node metastasis in
paraaortic lymph node dissection group(12% and 31,7%; p=0,07). 84% in the sentinel algorithm
group and 92,7% in the paraaortic lymph node dissection group, respectively, received adjuvant
therapy (p=0,02). Overall, four patients recurred within the first three year following surgery, two
patients had systematic multiple metastasis and both of them died due to disease. There was no
significant difference between the two groups in terms of overall survival (p = 0.252), disease
specific survival (p = 0.10) and disease free survival (p = 0.577). The mean follow-up period was
calculated as 29.33 months.
Conclusion: To date, there is no prospective study focused on whether sentinel lymphadenectomy
in endometrial cancer is sufficient for management of moderate high-risk endometrial cancer and to
establish the necessity of paraaortic lymphadenectomy in this patient group. Our study indicates that
for clinically uterine confined intermediate-high risk endometrial cancer patients sentinel lymph
node algorithm can be sufficient. Further studies are needed to confirm this finding.

Keywords

paraaortic lymphadenectomy, endometrial cancer, sentinel mapping

Supporting Institution

none

Project Number

-

Thanks

none

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