Sentinel node mapping in endometrial cancer

Abstract

Nodal status is one of the most important prognostic factors for patients with apparent early stage endometrial cancer. The role of retroperitoneal staging in endometrial cancer is controversial. Nodal status provides useful prognostic data, and allows to tailor the need of postoperative treatments. However, two independent randomized trials showed that the execution of (pelvic) lymphadenectomy increases the risk of having surgery-related complication without improving patients’ outcomes. Sentinel node mapping aims to achieve data regarding nodal status without increasing morbidity. Sentinel node mapping is the removal of first (clinically negative) lymph nodes draining the uterus. Several studies suggested that sentinel node mapping is not inferior to lymphadenectomy in identifying patients with nodal disease. More importantly, thorough ultrastaging sentinel node mapping allows the detection of low volume disease (micrometastases and isolated tumor cells), that are not always detectable via conventional pathological examination. Therefore, the adoption of sentinel node mapping guarantees a higher identification of patients with nodal disease than lymphadenectomy. Further evidence is needed to assess the value of various adjuvant strategies in patients with low volume disease and to tailor those treatments also on the basis of the molecular and genomic characterization of endometrial tumors.

Analysis of Risk Factors for Secondary Endometrial Cancer-Related Death: A SEER-Based Study

“…While an increasing number of studies are investigating the use of sentinel lymph node mapping in patients with endometrial cancer, we were unable to include this factor in our analysis due to the absence of relevant data in the SEER database. 27 , 28 …”

Health-Related Quality of Life after Hysterectomy for Endometrial Cancer: The Impact of Enhanced Recovery after Surgery Shifting Paradigm

“…This study showed that the health-related quality of life of women affected by endometrial cancer and treated with surgery is significantly better when a perioperative management strategy according to ERAS is adopted. In recent years, introducing a novel molecular classification for endometrial cancer has led to an important shift toward tailoring of the adjuvant treatment that is based not only on pathological data [13,14,16]. In this context, the need for an improvement in the HRQL after surgery for this type of cancer is of paramount importance to deliver the most appropriate post-operative treatment by ensuring an optimal well-being of the woman.…”

“…We included patients with confirmed early stage disease (FIGO I) and endometrioid histotype, classified according to European Society of Gynecological Oncology (ESGO) -European Society for Radiotherapy and Oncology (ESTRO) -European Society of Pathology (ESP) risk stratification model, that underwent hysterectomy, bilateral salpingo-oophorectomy, and lymph nodal assessment (including lymph node sampling, sentinel lymph node technique, and systematic pelvic bilateral lymphadenectomy). We included all the patients regardless of the type of lymph nodal staging based on the current evidence that a minimalistic approach, such as the use of sentinel lymph node technique, is the standard [13]. Unfortunately, even with the recent advances in the classification of endometrial cancer, we cannot include molecular data for the evaluation because of the enrolling period of the study and the purposes of the service evaluation of the auditing [14].…”

vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series

“…This allows for a higher identification of patients with nodal disease via sentinel node mapping than via lymphadenectomy. 3 Standard laparoscopic sentinel node dissection, however, can be technically challenging, especially in an obese population, which affects a significant share of patients with endometrial cancer. 1 Hysterectomy by natural orifice transluminal endoscopic surgery (vNOTES) is a minimally invasive technique using vaginal surgical access eliminating the need for abdominal incisions.…”

“…This allows for a higher identification of patients with nodal disease via sentinel node mapping than via lymphadenectomy. 3 Standard laparoscopic sentinel node dissection, however, can be technically challenging, especially in an obese population, which affects a significant share of patients with endometrial cancer. 1 …”