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

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

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