# Role of Lymphadenectomy in the Management of Early-Stage Endometrial Cancer

## TL;DR

This study examines whether removing lymph nodes during surgery improves survival in early-stage endometrial cancer patients.

## Contribution

The study provides insights into the clinical utility of pelvic lymphadenectomy in early-stage endometrial cancer management in low-resource settings.

## Key findings

- Only six patients had nodal-positive disease, with only three showing lymphadenopathy on scans.
- Patients with lymph node-positive disease had no recurrence after adjuvant treatment.
- Laparoscopic surgery was used in 65.2% of cases.

## Abstract

Objective

This study aimed to determine the role of pelvic lymphadenectomy by assessing nodal positivity on progression-free and overall survival in early-stage endometrial cancer.

Materials and methods

Eighty-nine women diagnosed with stage I/II endometrial cancer at presentation who underwent pelvic lymphadenectomy during surgery from 2019 to 2023 were included in this retrospective study. Data was collected using the Hospital Information System (HIS), and patient identifiers were anonymized. In addition to patient characteristics, final histopathology including cytology, type of surgery (laparoscopic vs. open), radiological evidence of lymphadenopathy before surgery, number of lymph nodes retrieved, histopathological evidence of nodal-positive/nodal-negative disease, adjuvant therapy (if any), recurrence-free survival, and overall survival were noted for these patients. Analysis was done using IBM SPSS Statistics for Windows, Version 25.0 (Released 2017; IBM Corp., Armonk, New York, United States), with means and frequencies noted for descriptive variables. Recurrence-free survival and overall survival were estimated in months for patients with lymph node-positive and lymph node-negative disease.

Results

Fifty-eight (65.2%) patients underwent laparoscopic surgery in this study cohort with radiological evidence of lymphadenopathy in 17 patients. Only six patients were found to have nodal-positive disease, out of which only three had lymphadenopathy on scans. Forty-six (51.7%) patients received adjuvant radiation therapy, while 16 (18%) underwent adjuvant chemotherapy. The estimated mean survival was 65.6 months, with the recurrence-free survival being 61.7 months. Among the patients with lymph node-positive disease, only one was found to have disease recurrence despite adjuvant treatment.

Conclusion

This study elucidates that patients who underwent pelvic lymphadenectomy and were subsequently found to have nodal disease went on to receive adequate adjuvant therapy; however, for some of them, there was no specific preoperative indicator to prompt the decision for pelvic lymphadenectomy. Therefore, until advanced techniques such as sentinel lymph node mapping are available in low-resource countries, surgical staging with pelvic nodal sampling is recommended.