From guidelines to clinical practice: the impact of sentinel lymph node mapping on surgical management in endometrial cancer.

Abstract

Sentinel lymph node (SLN) mapping using indocyanine green (ICG) fluorescence has emerged as a less invasive alternative to systematic lymphadenectomy in the surgical management of early-stage endometrial cancer. This study aimed to evaluate the feasibility, accuracy, and clinical outcomes of SLN mapping integrated into laparoscopic staging for endometrial cancer based on our institutional experience. A retrospective study was conducted on 29 patients with early-stage endometrial cancer who underwent laparoscopic hysterectomy with bilateral salpingo-oophorectomy and SLN mapping using ICG. Detection rates, histopathological findings, complication rates, and follow-up outcomes were recorded. SLN detection was successful in 100% of patients, with bilateral mapping achieved in 75.9% of cases. Metastatic involvement was found in 13.8% of cases, with micrometastases detected through ultrastaging. No significant intraoperative or postoperative complications were reported. Risk-adapted adjuvant treatment was administered according to ESGO/ESTRO/ESP guidelines. After a median follow-up of 18 months, 93.1% of patients remained disease-free. SLN mapping with ICG is a reliable and safe technique for lymphatic staging in endometrial cancer, enabling accurate nodal assessment while minimizing surgical morbidity. These findings support the routine implementation of this approach in the laparoscopic management of early-stage disease.