Lymphadenectomy and Sentinel Lymph Node Biopsy in Patients with Endometrial Cancer in Intermediate and High-Intermediate Risk Groups: The Ukrainian Experience.

Abstract

Purpose: To analyze the oncological safety of sentinel lymph node biopsy compared to lymphadenectomy. Additionally, we evaluated the postoperative complications of the two methods.

Patients and methods: This retrospective multicenter trial included 118 patients with intermediate and high-intermediate Stage I-II endometrioid endometrial cancer. Patients with non-endometrioid tumors and those with lymphadenopathy detected on computed tomography were excluded. The study group underwent sentinel lymph node biopsy. In contrast, the control group underwent systematic lymphadenectomy up to the renal vessels, the level of the inferior mesenteric artery, or the bifurcation of the iliac vessels. Recurrence-free survival was calculated using the Kaplan-Meier method. Differences were considered statistically significant at p < 0.05 (95% confidence interval).

Results: Patients were recruited from 2017 to March 2024. In the control group, six (5.9%) patients experienced disease recurrence and five (4.2%) died. Overall, two (1.7%) patients from both groups died from causes unrelated to recurrence. Recurrence-free survival did not significantly differ between those who underwent sentinel lymph node biopsy (96.3%, SE ± 0.036) and those who underwent lymphadenectomy (89.4%, SE ± 0.045) over 3 years from the date of surgery to the time of the first recurrence (p = 0.608). Eighteen postoperative complications were identified: 11 (9.3%) patients experienced complications within 30 days of follow-up, and 7 (5.9%) within 90 days.

Conclusion: Sentinel lymph node biopsy may serve as an alternative to systemic lymphadenectomy for surgical staging without compromising recurrence-free survival.