Sentinel Lymph Node Biopsy Vs Pelvic Lymphadenectomy In Early-Stage Endometrial Cancers: Feasibility, Safety and Lymphatic Morbidity

Saira  Saeed; Uzma Gul; Uzma Urooj; Sumaira  Khan

doi:10.51253/pafmj.v76iSUPPL-6.13876

Authors

Saira Saeed Department of Obstetrics and Gynecology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Uzma Gul Department of Obstetrics and Gynecology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Uzma Urooj Department of Obstetrics and Gynecology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan
Sumaira Khan Department of Obstetrics and Gynecology, Combined Military Hospital Rawalpindi/National University of Medical Sciences (NUMS) Pakistan

DOI:

https://doi.org/10.51253/pafmj.v76iSUPPL-6.13876

Keywords:

Endometrial Neoplasms, Lymphedema, Sentinel lymph node biopsy

Abstract

Objective: To compare sentinel lymph node biopsy (SLNB) and pelvic lymphadenectomy (PLND) in early-stage endometrial cancers in terms of feasibility, operative outcomes, lymphatic and other complications.

Study Design: Quasi experimental study.

Place and duration of study: Department of Obstetrics and Gynecology, Combined Military Hospital (CMH), Rawalpindi, Jun 2023 to Jun 2025

Methodology: This study retrospectively analyzed 28 women, with histologically confirmed, early stage (I-II) endometrial cancer, who had undergone complete surgical staging. Using Technetium 99 and blue dye, 16 patients had undergone sentinel lymph node biopsy whereas 12 patients had pelvic lymphadenectomy. Both groups were compared in terms of demographics, tumor characteristics, operative factors, postoperative outcomes including length of hospital stay, incidence of postoperative infection and lower limb lymphedema. Patients were followed up for 30 days post-surgery.

Results: Mean age of patients was 56.07±6.57 years. There was no significant difference between the groups regarding demographics and tumor characteristics (p>0.05). Endometrioid adenocarcinoma was the most common histology (85.70%). Mean operative time was significantly shorter in the sentinel lymph node biopsy group as compared to pelvic lymphadenectomy (125.80 ± 44.00 vs 247.90 ± 48.40 min, p <0.001). Incidence of lower limb lymphedema was also lesser with sentinel lymph node biopsy (0.00% vs 50.00%, p=0.002). No significant differences were observed in blood loss, nodal positivity or post-operative infection (p>0.05).

Conclusion: Sentinel lymph node biopsy in early-stage endometrial cancer is associated with significantly shorter operative time and a lower incidence of lower limb lymphedema compared with pelvic lymphadenectomy, making it a feasible alternative that

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References

1. Wasim T, Mushtaq J, Wasim AZ, Gul-e-Raana. Gynecological malignancies at tertiary care hospital, Pakistan: a five-year review. Pak J Med Sci. 2021; 37(3): 621-627. https://doi.org/10.12669/pjms.37.3.3596

2. Tufail M, Wu C. Cancer statistics in Pakistan from 1994 to 2021: data from cancer registry. JCO Clin Cancer Inform. 2023; 7: e2200142. https://doi.org/10.1200/CCI.22.00142

3. Khalil KA, Habib M, Hussain S, Usman M, Syed AA. Role of lymphadenectomy in the management of early-stage endometrial cancer. Cureus. 2025; 17(4): e82408.

https://doi.org/10.7759/cureus.82408

4. Nagar H, Wietek N, Goodall RJ, Hughes W, Schmidt-Hansen M, Morrison J. Sentinel node biopsy for diagnosis of lymph node involvement in endometrial cancer. Cochrane Database Syst Rev. 2021; 6: CD013021.

https://doi.org/10.1002/14651858.CD013021.pub2

5. Daniilidis A, Margioula-Siarkou C, Margioula-Siarkou G, Papandreou P, Papanikolaou A, Dinas K, et al. Sentinel lymph node mapping in endometrial cancer to reduce surgical morbidity: always, sometimes, or never. Prz Menopauzalny. 2022; 21(3): 207-213.

https://doi.org/10.5114/pm.2022.119862

6. Salman L, Cusimano MC, Marchocki Z, Ferguson SE. Sentinel lymph node mapping in endometrial cancer: current evidence and practice. J Surg Oncol. 2024; 129(1): 117-119. https://doi.org/10.1002/jso.27550

7. Chishti U, Aziz AB, Akhtar M, Sheikh S. Selective lymphadenectomy in endometrial cancer: retrospective analysis of morbidity and survival data at a tertiary care centre. Pak J Med Sci. 2015; 31(4): 950-955.

https://doi.org/10.12669/pjms.314.7593

8. Masroor I, Afzal S, Pathan H. Accuracy of diffusion weighted imaging in assessment of pelvic lymph node metastasis in patients with endometrial cancer. J Coll Physicians Surg Pak. 2023; 33(7): 738-741. https://doi.org/10.29271/jcpsp.2023.07.738

9. Sehar T, Zafar M, Aslam S, Bano N, Naseer A, Kumar S. Outcome of radical hysterectomy with nodal dissection in endometrial tumors. J Soc Obstet Gynaecol Pak. 2023; 13(3): 256-260. Available from:

https://jsogp.net/index.php/jsogp/article/view/638

10. Yost KJ, Cheville AL, Weaver AL, Al Hilli M, Dowdy SC. Development and validation of a self-report lower-extremity lymphedema screening questionnaire in women. Phys Ther. 2013; 93(5): 694-703. https://doi.org/10.2522/ptj.20120088

11. Bogani G, Papadia A, Buda A, Casarin J, Di Donato V, Plotti F, et al. Factors predicting morbidity in surgically-staged high-risk endometrial cancer patients. Eur J Obstet Gynecol Reprod Biol. 2021; 266: 169-174.

https://doi.org/10.1016/j.ejogrb.2021.09.029

12. Mauro J, Raimando D, Di Martino G, Gasparri ML, Restaino S, Neola D, et al. Assessment of sentinel lymph node mapping with different volumes of indocyanine green in early stage endometrial cancer: the ALIEN study. Int J Gynecol Cancer. 2024; 34(6): 824-829.

https://doi.org/10.1136/ijgc-2023-005100

13. Torrent A, Amengual J, Ruiz A, Serra A, Fuertes L, Sampol CM, et al. Impact of lymph node staging techniques on lymphedema and quality of life in early-stage endometrial cancer: a prospective cohort study. Gynecol Oncol Rep. 2025; 60: 101919.

https://doi.org/10.1016/j.gore.2025.101919

14. Bjørnholt SM, Groenvold M, Petersen MA, Mogensen O, Bouchelouche K, Sponholtz SE, et al. Patient reported lymphedema after sentinel lymph node mapping in women with low grade endometrial cancer. Am J Obstet Gynecol. 2025; 232(3): 306.e1-11. https://doi.org/10.1016/j.ajog.2024.09.001

15. Kundur M, Rajanbabu A. Lymphedema in patients undergoing surgery for endometrial cancer: a comparative study of sentinel node biopsy versus complete pelvic node dissection. J Obstet Gynecol India. 2025; 75(Suppl 1): 18-22.

https://doi.org/10.1007/s13224-024-01968-8

16. Makroum AA, Lee YJ, Lee J-Y, Nam EJ, Kim S, Kim SW, et al. Comparison of oncological outcomes between sentinel lymph node biopsy and complete lymphadenectomy for endometrial cancer. J Obstet Gynaecol Res. 2023; 49(8): 2118-2125.

https://doi.org/10.1111/jog.15707

17. Khoptiana O, Svintsitskyi V, Nespryadko S, Tsip NP, Gogisvanidze T, Dzimistarishvili M, et al. Lymphadenectomy and sentinel lymph node biopsy in patients with endometrial cancer in intermediate and high-intermediate risk groups: the Ukrainian experience. Int J Womens Health. 2025; 17: 1877-1885. https://doi.org/10.2147/IJWH.S521303

18. Casarin J, Multinu F, Tortorella L, Cappuccio S, Weaver AL, Ghezzi F, et al. Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes. Int J Gynecol Cancer. 2020; 30(1): 41-47.

https://doi.org/10.1136/ijgc-2019-000672