# Minimally Invasive Surgery With Sentinel Lymph Node Mapping in Elderly Patients With Early-Stage Endometrial Cancer: A Subgroup Analysis of a Prospective Cohort Study

## TL;DR

This study shows that minimally invasive surgery with lymph node mapping is safe and effective for elderly patients with early-stage endometrial cancer.

## Contribution

The study demonstrates that age should not limit surgery for early-stage endometrial cancer in elderly patients.

## Key findings

- Elderly patients had lower bilateral sentinel lymph node detection but no intraoperative complications.
- Postoperative complication rates and recurrence-free survival were similar between age groups.
- Older patients had higher-risk tumor features but equivalent surgical and oncological outcomes.

## Abstract

Objective

The objective of this study is to evaluate the surgical safety and oncological outcomes of minimally invasive surgery (MIS) with sentinel lymph node (SN) mapping in older adults (≥70 years) with early-stage endometrial cancer, as part of a prospective cohort study.

Methods

This study is a subgroup analysis of a prospective cohort comprising 204 patients with International Federation of Gynecology and Obstetrics stage IA endometrial cancer who underwent MIS with SN mapping at a single tertiary center between December 2016 and April 2022. Patients were categorized into two groups based on age: <70 years and ≥70 years. Perioperative outcomes, SN detection rates, and survival outcomes were compared between the two groups.

Results

Of the total cohort, 29 patients were aged ≥70 years. Non-endometrioid histology (6.9% vs. 1.1%, P = 0.039) and deep myometrial invasion (27.6% vs. 11.4%, P = 0.019) were more common in the older adults group. Although bilateral SN detection was lower in elderly patients (72.4% vs. 91.4%, P = 0.011), no intraoperative complications occurred in this group. Postoperative complication rates and recurrence-free survival (93% vs. 97.1%, P = 0.29) were comparable across groups.

Conclusion

MIS with SN mapping is a safe and feasible approach for older adults with early-stage endometrial cancer. Despite higher-risk pathological features, older patients had equivalent surgical and oncological outcomes. Age alone should not preclude surgical treatment; instead, decisions should be based on functional status and preoperative evaluation.