Sentinel lymph node biopsy in endometrial cancer-Feasibility, safety and lymphatic complications

Gynecol Oncol. 2018 Mar;148(3):491-498. doi: 10.1016/j.ygyno.2017.12.017. Epub 2017 Dec 20.


Objective: To compare the rate of lymphatic complications in women with endometrial cancer undergoing sentinel lymph node biopsy versus a full pelvic and infrarenal paraaortic lymphadenectomy, and to examine the overall feasibility and safety of the former.

Methods: A prospective study of 188 patients with endometrial cancer planned for robotic surgery. Indocyanine green was used to identify the sentinel lymph nodes. In low-risk patients the lymphadenectomy was restricted to removal of sentinel lymph nodes whereas in high-risk patients also a full lymphadenectomy was performed. The impact of the extent of the lymphadenectomy on the rate of complications was evaluated.

Results: The bilateral detection rate of sentinel lymph nodes was 96% after cervical tracer injection. No intraoperative complication was associated with the sentinel lymph node biopsy per se. Compared with hysterectomy alone, the additional average operative time for removal of sentinel lymph nodes was 33min whereas 91min were saved compared with a full pelvic and paraaortic lymphadenectomy. Sentinel lymph node biopsy alone resulted in a lower incidence of leg lymphedema than infrarenal paraaortic and pelvic lymphadenectomy (1.3% vs 18.1%, p=0.0003).

Conclusion: The high feasibility, the absence of intraoperative complications and the low risk of lymphatic complications supports implementing detection of sentinel lymph nodes in low-risk endometrial cancer patients. Given that available preliminary data on sensitivity and false negative rates in high-risk patients are confirmed in further studies, we also believe that the reduction in lymphatic complications and operative time strongly motivates the sentinel lymph node concept in high-risk endometrial cancer.

Keywords: Chylous ascites; Endometrial cancer; Indocyanine green; Lymphadenectomy; Lymphatic metastases; Lymphatic system; Lymphedema; Lymphocele; Sentinel lymph node biopsy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Abdomen
  • Adenocarcinoma, Clear Cell / pathology*
  • Adenocarcinoma, Clear Cell / surgery
  • Adult
  • Aged
  • Aged, 80 and over
  • Carcinoma, Endometrioid / pathology*
  • Carcinoma, Endometrioid / surgery
  • Carcinosarcoma / pathology*
  • Carcinosarcoma / surgery
  • Chemoradiotherapy, Adjuvant
  • Coloring Agents
  • Endometrial Neoplasms / pathology*
  • Endometrial Neoplasms / surgery
  • Feasibility Studies
  • Female
  • Humans
  • Hysterectomy / methods
  • Indocyanine Green
  • Intraoperative Complications / epidemiology
  • Lower Extremity
  • Lymph Node Excision / methods
  • Lymphedema / epidemiology*
  • Lymphocele / epidemiology*
  • Middle Aged
  • Neoplasms, Cystic, Mucinous, and Serous / pathology*
  • Neoplasms, Cystic, Mucinous, and Serous / surgery
  • Pelvis
  • Postoperative Complications / epidemiology*
  • Robotic Surgical Procedures / methods
  • Sentinel Lymph Node Biopsy / methods*


  • Coloring Agents
  • Indocyanine Green