Sentinel Node Biopsy Versus Pelvic Lymphadenectomy in the Prognostic Staging of Endometrial Cancer

OBJECTIVES: To evaluate the effectiveness and safety of selective sentinel lymph node biopsy (SSLNB) in the staging of endometrial cancer (EC) versus routine pelvic lymphadenectomy (PL), in patients with low or intermediate-risk involvement in early stages and with intermediate/high or high-risk EC.

METHODS: Several bibliographic search strategies were defined for different databases (MEDLINE, EMBASE, WOS, Cochrane Library). For quality assessment, AMSTAR-2 tool was used for systematic reviews (SR) and the Newcastle-Ottawa Scale for observational studies. Evidence synthesis was performed using the GRADE methodology.

RESULTS: 4 studies were selected: 2 (SR) to answer the efficacy question and 2 studies (1 SR and 1 observational study) to answer the safety question. In EC of all risks, the identified SR shows that women who undergo SSLNB have the same overall survival, disease-free survival, and recurrence rate as those who underwent lymphadenectomy. It also identified more positive pelvic nodes than lymphadenectomy, although not para-aortic. All this, with a lower risk of bleeding during the surgical procedure, which is also shorter. Similar results were obtained in women with high-risk, with no differences in terms of overall survival and progression-free survival. In the SR that evaluates these results, the rates of lymphovascular invasion, chemotherapy and radiotherapy were also measured, and it can be inferred that SSLNB versus lymphadenectomy does not worsen oncological outcomes in terms of survival or indicators of progression.

CONCLUSIONS:

SSLNB is at least as effective as PL for the staging of EC of any risk with no differences between both techniques in terms of overall survival and progression-free survival. SSLNB results in fewer surgical complications and a lower risk of lower limb lymphedema.

In short, SSLNB would be an equally effective but safer alternative to PL for the prognostic evaluation of EC, although this evidence obtained from observational studies should be corroborated by randomized clinical trials.