Three Lymphadenectomy Strategies in Endometrial Carcinoma: Analysis of Long-Term Outcomes

Study Objective Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. Design This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. Setting Referral centers. Patients or Participants Consecutive patients with EC undergoing surgical staging. Interventions Surgical staging including SNM and/or lymphadenectomy. Measurements and Main Results Charts of 1,338 patients were evaluated: 398 (29.7%), 174 (13.1%), 187 (13.9%), and 579 (43.3%) no retroperitoneal staging, SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomies. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors (p>0.2). Conclusion Our study highlighted that SNM provides similar long-term oncologic outcomes than lymphadenectomy. Randomized controlled trials are needed to corroborate the value of SNM in EC. Sentinel node mapping (SNM) has replaced lymphadenectomy for staging surgery in apparent early-stage endometrial cancer (EC). Here, we evaluated the long-term survival of three different approaches of nodal assessment. This is a multi-institutional retrospective study evaluating long-term outcomes (at least 3 years of follow-up) of EC patients having nodal assessment between 2006 and 2016. In order to reduce possible confounding factors, we applied a propensity-matched algorithm. Referral centers. Consecutive patients with EC undergoing surgical staging. Surgical staging including SNM and/or lymphadenectomy. Charts of 1,338 patients were evaluated: 398 (29.7%), 174 (13.1%), 187 (13.9%), and 579 (43.3%) no retroperitoneal staging, SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Applying a propensity score matching algorithm (1:1:2) we selected 500 patients: 125 SNM vs. 125 SNM plus backup lymphadenectomy vs. 250 lymphadenectomies. Baseline characteristics of the study population were similar between groups. The prevalence of nodal disease was 14%, 16%, and 12% in patients having SNM, SNM followed by backup lymphadenectomy and lymphadenectomy, respectively. Overall, 19 (7.6%) patients were diagnosed with low volume nodal disease. The mean (SD) follow-up time was 62 (±11) months. The survival analysis comparing the three techniques did not show statistical differences in terms of disease-free (p=0.750) and overall survival (p=0.899). Similarly, the type of nodal assessment did not impact survival outcomes after stratification on the basis of uterine risk factors (p>0.2). Our study highlighted that SNM provides similar long-term oncologic outcomes than lymphadenectomy. Randomized controlled trials are needed to corroborate the value of SNM in EC.