Skip to main content
SpringerLink
Log in

Lymphadenectomy in Endometrial Cancers—A Review

  • Review Article
  • Published:
Indian Journal of Gynecologic Oncology Aims and scope Submit manuscript

Abstract

Most endometrial cancers are diagnosed in an early stage, and nearly three-fourths do not require any lymph node clearance. Surgical staging is considered the gold standard, but the role of lymphadenectomy is unclear. Most patients with endometrial cancers have other medical co-morbidities like hypertension, diabetes, obesity and remain high risk for prolonged procedures. The reported risk of lymphedema according to published literature could be as high as 30% vis-a-vis a 10% risk of upstaging with lymph node clearance. The confounding factors in endometrial cancers are the depth of myometrial invasion, tumor size, histology, tumor grade and variable lymphatic pathways. Visual inspection/palpation of the nodes or berry-picking enlarged nodes remain poor predictors of nodal involvement. The extent of clearance by convention ranges from bilateral pelvic only or addition of a formal retroperitoneal clearance upto the left renal vein. Adjuvant treatment for patients diagnosed with advanced-stage cancer after a comprehensive lymphadenectomy is not uniform. The path forward appears to revolve around sentinel mapping. Lymphadenectomy can be omitted in the low-risk group, while a cervical injection-based pelvic sentinel mapping can be performed in the intermediate-risk group. However, in the high-risk/ultrahigh-risk subgroups, para-aortic sentinel node mapping is needed. If there are no SLNs identified with a cervical injection, an additional corporeal ICG injection may be needed. This approach needs to be based on an institutional algorithm with the incorporation of ultrastaging. An additional benefit of the sentinel approach is a focused histopathological analysis of the most relevant nodes. Various dyes have been evaluated for sentinel mapping, methylene blue being the cheapest though studies show indocyanine green to be the safer alternative with better results.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Practice Bulletin No. 149: Endometrial cancer. Obstet Gynecol. 2015 Apr;125(4):1006–26

  2. El-Agwany AS, Meleis MH. Value and best way for detection of Sentinel lymph node in early stage endometrial cancer: selective lymphadenectomy algorithm. Eur J Obstet Gynecol Reprod Biol. 2018;225:35–9.

    Article  Google Scholar 

  3. Geppert B, Lönnerfors C, Bollino M, Arechvo A, Persson J. A study on uterine lymphatic anatomy for standardization of pelvic sentinel lymph node detection in endometrial cancer. Gynecol Oncol. 2017;145(2):256–61.

    Article  Google Scholar 

  4. Paño B, Sebastià C, Ripoll E, Paredes P, Salvador R, Buñesch L, et al. Pathways of lymphatic spread in gynecologic malignancies. Radiographics. 2015;35(3):916–45.

    Article  Google Scholar 

  5. Kumar S, Podratz KC, Bakkum-Gamez JN, Dowdy SC, Weaver AL, McGree ME, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol. 2014;132(1):38–43.

    Article  Google Scholar 

  6. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11–8.

    Article  Google Scholar 

  7. Li M-Y, Hu X-X, Zhong J-H, Chen L-L, Lin Y-X. Therapeutic role of systematic lymphadenectomy in early-stage endometrial cancer: a systematic review. Oncol Lett. 2016;11(6):3849–57.

    Article  CAS  Google Scholar 

  8. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, et al. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.

    Article  Google Scholar 

  9. Kitchner H. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. The Lancet. 2009;373(9658):125–36.

    Article  Google Scholar 

  10. Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence. J Obstet Gynaecol Res. 2014;40(2):301–11.

    Article  Google Scholar 

  11. Abdelazim IA, Abu-Faza M, Zhurabekova G, Shikanova S, Karimova B, Sarsembayev M, et al. Sentinel lymph nodes in endometrial cancer update 2018. Gynecol Minim Invasive Ther. 2019;8(3):94–100.

    Article  Google Scholar 

  12. Sentinel lymph node procedure in endometrial cancer: A systematic review and proposal for standardization of future research- ClinicalKey [Internet]. [cited 2020 Nov 9]. Available from: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0090825815300214?returnurl=https:%2F%2Flinkinghub.elsevier.com%2Fretrieve%2Fpii%2FS0090825815300214%3Fshowall%3Dtrue&referrer=https:%2F%2Fpubmed.ncbi.nlm.nih.gov%2F

  13. Cormier B, Rozenholc AT, Gotlieb W, Plante M, Giede C. Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research. Gynecol Oncol. 2015;138(2):478–85.

    Article  Google Scholar 

  14. How J, Gotlieb WH, Press JZ, Abitbol J, Pelmus M, Ferenczy A, et al. Comparing indocyanine green, technetium, and blue dye for sentinel lymph node mapping in endometrial cancer. Gynecol Oncol. 2015;137(3):436–42.

    Article  CAS  Google Scholar 

  15. Boni L, David G, Mangano A, Dionigi G, Rausei S, Spampatti S, et al. Clinical applications of indocyanine green (ICG) enhanced fluorescence in laparoscopic surgery. Surg Endosc. 2015;29(7):2046–55.

    Article  Google Scholar 

  16. Fanfani F, Monterossi G, Ghizzoni V, Rossi ED, Dinoi G, Inzani F, et al. One-step nucleic acid amplification (OSNA): a fast molecular test based on CK19 mRNA concentration for assessment of lymph-nodes metastases in early stage endometrial cancer. PLOS One. 2018;13(4):e0195877.

    Article  Google Scholar 

  17. Touhami O, Trinh X-B, Gregoire J, Sebastianelli A, Renaud M-C, Grondin K, et al. Predictors of non-sentinel lymph node (non-SLN) metastasis in patients with sentinel lymph node (SLN) metastasis in endometrial cancer. Gynecol Oncol. 2015;138(1):41–5.

    Article  Google Scholar 

  18. Zuo J, Wu LY, Cheng M, Bai P, Lei CZ, Li N, et al. Comparison study of laparoscopic sentinel lymph node mapping in endometrial carcinoma using carbon nanoparticles and lymphatic pathway verification. J Minim Invasive Gynecol. 2019;26(6):1125–32.

    Article  Google Scholar 

  19. López–De la Manzanara Cano C, Cordero García JM, Martín-Francisco C, Pascual-Ramírez J, Parra CP, Céspedes Casas C. ATL: a prospective study. Int J Gynecol Cancer. 2014;24(6):1048–53.

    Article  Google Scholar 

  20. Basaran D, Leitao MM. Update on sentinel lymph node mapping in endometrial cancer patients with a high risk for nodal metastasis. Indian J Gynecol Oncol. 2020;18(2):43.

    Article  Google Scholar 

  21. Carlson JW, Kauderer J, Hutson A, Carter J, Armer J, Lockwood S, et al. GOG 244-The lymphedema and gynecologic cancer (LEG) study: Incidence and risk factors in newly diagnosed patients. Gynecol Oncol. 2020;156(2):467–74.

    Article  Google Scholar 

  22. Ballester M, Dubernard G, Lécuru F, Heitz D, Mathevet P, Marret H, et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.

    Article  Google Scholar 

  23. Della Corte L, Giampaolino P, Mercorio A, Riemma G, Schiattarella A, De Franciscis P, et al. Sentinel lymph node biopsy in endometrial cancer: state of the art. Transl Cancer Res. 2020;9(12):7725–33.

    Article  Google Scholar 

  24. How J, Lau S, Press J, Ferenczy A, Pelmus M, Stern J, et al. Accuracy of sentinel lymph node detection following intra-operative cervical injection for endometrial cancer: a prospective study. Gynecol Oncol. 2012;127(2):332–7.

    Article  Google Scholar 

Download references

Funding

No funding received.

Author information

Authors and Affiliations

  1. Division of Gynecologic Oncology, Department of Surgical Oncology, Basavatarakam Indo-American Cancer Hospital and Research Institute, Road No 10, Banjara Hills, Opp K.B.R. Park, Hyderabad, 500034, Telangana, India

    Subramanyeshwar Rao Thammineedi, R. Rajagopalan Iyer, Boleneni Naren & Sujit Chyau Patnaik

Authors
  1. Subramanyeshwar Rao Thammineedi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Rajagopalan Iyer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Boleneni Naren
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Sujit Chyau Patnaik
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. Rajagopalan Iyer.

Ethics declarations

Conflict of interest

No conflict of interest for any authors.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Thammineedi, S.R., Iyer, R.R., Naren, B. et al. Lymphadenectomy in Endometrial Cancers—A Review. Indian J Gynecol Oncolog 19, 77 (2021). https://doi.org/10.1007/s40944-021-00562-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s40944-021-00562-4

Keywords

Search

Navigation