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Sentinel lymph node biopsy at robotic-assisted hysterectomy for atypical hyperplasia and endometrial cancer

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Abstract

Lymph node (LN) evaluation in endometrial cancer is controversial. Sentinel lymph node biopsy (SLNB) allows for an accurate nodal assessment while minimising the risks of a full pelvic lymph node dissection (PLND). The aims of this study are to examine the characteristics and peri-operative outcomes of women with atypical hyperplasia (AH) or endometrial cancer undergoing robotic-assisted hysterectomy (RAH) ± SLNB or PLND; to examine the utilisation, feasibility and role of SLNB and compare their peri-operative outcomes. Retrospective cohort study from December 2018 to February 2021 of women who underwent RAH ± LN assessment for endometrial cancer or AH. 115 women underwent RAH. 59% had SLNB, 29% had no LN assessment, and 12% had PLND. The final diagnosis was mostly early stage low-grade disease; Stage 1A—50%, Grade 1 endometrioid adenocarcinoma (EAC)—56%. The detection rate was 90%. There was a statistically significant trend towards performing SLNB over time (P value 0.004). There was a statistically shorter length of stay, less estimated blood loss, and shorter surgical duration in the SLNB cohort, compared to the no LN assessment cohort (P values 0.02, 0.01, and 0.03, respectively). There was statistically significant less estimated blood loss and surgical duration in the SLNB compared to the PLND cohort (P values 0.03 and 0.001, respectively). SLNB at RAH was utilised and feasible. It was safe with a low complication rate and had advantages compared to PLND cohort. SLNB should be considered in suitable selected women undergoing surgery for endometrial cancer or AH.

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No funding was obtained to conduct this research.

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Authors and Affiliations

  1. Gynaecology Oncology Department, Liverpool Hospital, Sydney, NSW, Australia

    Vanessa El-Achi, Michael Burling & Murad Al-Aker

  2. Westmead Hospital, Sydney, NSW, Australia

    Michael Burling

Authors
  1. Vanessa El-Achi
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  2. Michael Burling
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  3. Murad Al-Aker
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Contributions

VE-A contributed to intellectual planning of the project, data collection, intellectual analysis of the data, and writing of the manuscript. MA-A and MB contributed to intellectual planning and revision of the paper.

Corresponding author

Correspondence to Vanessa El-Achi.

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Conflict of interest

The authors, Dr Vanessa El-Achi, Dr Michael Burling, and Dr Murad Al-Aker declare that they have no conflict of interest.

Ethics approval

This research project was approved by the local institution ethics committees: South Western Sydney Local Health District (2021/ETH01079 and 2021/STE02091).

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El-Achi, V., Burling, M. & Al-Aker, M. Sentinel lymph node biopsy at robotic-assisted hysterectomy for atypical hyperplasia and endometrial cancer. J Robotic Surg 16, 1111–1115 (2022). https://doi.org/10.1007/s11701-021-01321-5

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  • DOI: https://doi.org/10.1007/s11701-021-01321-5

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