Lymphatic Complications Following Sentinel Node Biopsy or Pelvic Lymphadenectomy for Endometrial Cancer

Sentinel node biopsy (SNB) is performed worldwide in patients with endometrial cancer (EC). The aim of this study was to evaluate and compare the occurrence rate of lymphatic complications between SNB and pelvic lymphadenectomy (LND) for EC. The medical records of women who underwent SNB or pelvic LND for EC between September 2012 and April 2022 were assessed. A total of 388 patients were enrolled in the current study. Among them, 201 patients underwent SNB and 187 patients underwent pelvic LND. The occurrence rates of lower-extremity lymphedema (LEL) and pelvic lymphocele (PL) were compared between the patients who underwent SNB and those who underwent pelvic LND. The SNB group had a significantly lower occurrence rate of lower-extremity LEL than the pelvic LND group (2.0% vs. 21.3%, p < 0.01). There were no patients who had PL in the SNB group; however, 4 (2.1%) patients in the pelvic LND group had PL. The occurrence rates of lower-extremity LEL and PL were significantly lower in patients who underwent SNB than those who underwent pelvic LND. SNB for EC has a lower risk of lymphatic complications compared to systemic LND.

[1]  I. Jürgenliemk-Schulz,et al.  Lymphocele following lymph node dissection in cervical and endometrial cancer: A systematic review and meta-analysis. , 2023, Gynecologic oncology.

[2]  K. Tse,et al.  Applications and Safety of Sentinel Lymph Node Biopsy in Endometrial Cancer , 2022, Journal of clinical medicine.

[3]  J. Hwang,et al.  The incidence of postoperative symptomatic lymphocele after pelvic lymphadenectomy between abdominal and laparoscopic approach: a systemic review and meta-analysis , 2022, Surgical Endoscopy.

[4]  J. How,et al.  Sentinel lymph node biopsy in high-grade endometrial cancer: a systematic review and meta-analysis of performance characteristics. , 2021, American journal of obstetrics and gynecology.

[5]  R. Granese,et al.  Surgical complications occurring during minimally invasive sentinel lymph node detection in endometrial cancer patients. A systematic review of the literature and metanalysis. , 2021, European journal of surgical oncology : the journal of the European Society of Surgical Oncology and the British Association of Surgical Oncology.

[6]  A. Weaver,et al.  Reduced lymphedema after sentinel lymph node biopsy versus lymphadenectomy for endometrial cancer , 2020, International Journal of Gynecological Cancer.

[7]  W. E. Richards,et al.  GOG 244 - The Lymphedema and Gynecologic cancer (LeG) study: The impact of lower-extremity lymphedema on quality of life, psychological adjustment, physical disability, and function. , 2020, Gynecologic oncology.

[8]  L. Rebegea,et al.  Associated risk factors of lower limb lymphedema after treatment of cervical and endometrial cancer , 2020, Experimental and therapeutic medicine.

[9]  L. Carlson,et al.  The Quality of Life and Psychosocial Implications of Cancer-Related Lower-Extremity Lymphedema: A Systematic Review of the Literature , 2020, Journal of clinical medicine.

[10]  J. Marcickiewicz,et al.  Incidence of lymphedema in the lower limbs and lymphocyst formation within one year of surgery for endometrial cancer: A prospective longitudinal multicenter study. , 2020, Gynecologic oncology.

[11]  M. Ohmichi,et al.  Oncologic outcomes for patients with endometrial cancer who received minimally invasive surgery: a retrospective observational study , 2020, International Journal of Clinical Oncology.

[12]  L. Ward,et al.  Incidence and risk factors for lower limb lymphedema associated with endometrial cancer: Results from a prospective, longitudinal cohort study. , 2020, Gynecologic oncology.

[13]  M. Ohmichi,et al.  The Diagnostic Accuracy of an Intraoperative Frozen Section Analysis and Imprint Cytology of Sentinel Node Biopsy Specimens from Patients with Uterine Cervical and Endometrial Cancer: a Retrospective Observational Study , 2020, Pathology & Oncology Research.

[14]  E. Aviki,et al.  Lower extremity lymphedema in patients with gynecologic malignancies , 2020, International Journal of Gynecological Cancer.

[15]  D. Alberts,et al.  GOG 244 - The LymphEdema and Gynecologic cancer (LEG) study: The association between the gynecologic cancer lymphedema questionnaire (GCLQ) and lymphedema of the lower extremity (LLE). , 2019, Gynecologic oncology.

[16]  A. Weaver,et al.  Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes , 2019, International Journal of Gynecological Cancer.

[17]  G. Bogani,et al.  Sentinel node mapping in endometrial cancer , 2019, Translational cancer research.

[18]  R. Reis,et al.  Sentinel Lymph Node Mapping vs Systematic Lymphadenectomy for Endometrial Cancer: Surgical Morbidity and Lymphatic Complications. , 2019, Journal of minimally invasive gynecology.

[19]  Shinnichi Sakamoto,et al.  Development and Themes of Diagnostic and Treatment Procedures for Secondary Leg Lymphedema in Patients with Gynecologic Cancers , 2019, Healthcare.

[20]  Jiali Luo,et al.  Lymphadenectomy and prognosis for elderly females with stage I endometrioid endometrial cancer , 2019, Archives of Gynecology and Obstetrics.

[21]  E. Rossi,et al.  Extent of lymphadenectomy and postoperative major complications among women with endometrial cancer treated with minimally invasive surgery , 2019, American journal of obstetrics and gynecology.

[22]  M. Ohmichi,et al.  The diagnostic accuracy of fluorodeoxyglucose-positron emission tomography/computed tomography and sentinel node biopsy in the prediction of pelvic lymph node metastasis in patients with endometrial cancer , 2018, Medicine.

[23]  D. Chi,et al.  Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy. , 2018, Gynecologic oncology.

[24]  D. Alberts,et al.  GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. , 2018, Gynecologic oncology.

[25]  J. Persson,et al.  Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications. , 2017, Gynecologic oncology.

[26]  M. Ohmichi,et al.  The detection of sentinel lymph nodes in laparoscopic surgery can eliminate systemic lymphadenectomy for patients with early stage endometrial cancer , 2017, International Journal of Clinical Oncology.

[27]  A. Bryant,et al.  Lymphadenectomy for the management of endometrial cancer. , 2017, The Cochrane database of systematic reviews.

[28]  Kidong Kim,et al.  Nomogram predicting risk of lymphocele in gynecologic cancer patients undergoing pelvic lymph node dissection , 2017, Obstetrics & gynecology science.

[29]  M. Fredrikson,et al.  Lymphedema after treatment for endometrial cancer - A review of prevalence and risk factors. , 2017, European journal of obstetrics, gynecology, and reproductive biology.

[30]  Vishnu Goutham Kota,et al.  Sentinel lymph node mapping in endometrial cancer: a systematic review and meta-analysis , 2017, Oncotarget.

[31]  A. Ivanova,et al.  A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): a multicentre, prospective, cohort study. , 2017, The Lancet. Oncology.

[32]  B. Hagen,et al.  Indocyanine green fluorescence imaging of lymph nodes during robotic-assisted laparoscopic operation for endometrial cancer. A prospective validation study using a sentinel lymph node surgical algorithm. , 2016, Gynecologic oncology.

[33]  Tae-Joong Kim,et al.  Survival impact based on the thoroughness of pelvic lymphadenectomy in intermediate- or high-risk groups of endometrioid-type endometrial cancer: A multi-center retrospective cohort analysis. , 2016, Gynecologic oncology.

[34]  Sarika Gupta,et al.  Sentinel lymph node mapping with staging lymphadenectomy for patients with endometrial cancer increases the detection of metastasis. , 2016, Gynecologic oncology.

[35]  Kumiko Goto,et al.  Prevalence, Classification, and Risk Factors for Postoperative Lower Extremity Lymphedema in Women With Gynecologic Malignancies: A Retrospective Study , 2015, International Journal of Gynecologic Cancer.

[36]  L. Dušek,et al.  A prospective study examining the incidence of asymptomatic and symptomatic lymphoceles following lymphadenectomy in patients with gynecological cancer. , 2015, Gynecologic oncology.

[37]  V. Torri,et al.  Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. , 2009, Journal of the National Cancer Institute.

[38]  Carol L. Brown,et al.  Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? , 2009, Gynecologic oncology.

[39]  M. Parmar,et al.  Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study , 2009, The Lancet.

[40]  J. Chan,et al.  The impact of the absolute number and ratio of positive lymph nodes on survival of endometrioid uterine cancer patients , 2007, British Journal of Cancer.

[41]  D. Smith,et al.  Survival impact of lymph node dissection in endometrial adenocarcinoma: a surveillance, epidemiology, and end results analysis , 2007, International Journal of Gynecologic Cancer.

[42]  J. Chan,et al.  Therapeutic role of lymph node resection in endometrioid corpus cancer , 2006, Cancer.

[43]  Young Tae Kim,et al.  An analysis of the risk factors and management of lymphocele after pelvic lymphadenectomy in patients with gynecologic malignancies. , 2004, Cancer research and treatment : official journal of Korean Cancer Association.

[44]  E. Trimble,et al.  Lymph node sampling and survival in endometrial cancer. , 1998, Gynecologic oncology.

[45]  Consensus Document,et al.  The Diagnosis and Treatment of Peripheral Lymphedema: 2016 Consensus Document of the International Society of Lymphology. , 2016, Lymphology.

[46]  M. Deveci,et al.  Pelvic-paraaortic lymphadenectomy in clinical Stage I endometrial adenocarcinoma: a multicenter study. , 2003, European journal of gynaecological oncology.

[47]  E. Partridge,et al.  Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. , 1995, Gynecologic oncology.

[48]  R. Kurman,et al.  Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: A gynecologic oncology group study , 1991 .