Implementation of a sentinel lymph node mapping algorithm for endometrial cancer: surgical outcomes and hospital charges

Int J Gynecol Cancer. 2020 Mar;30(3):352-357. doi: 10.1136/ijgc-2019-000941. Epub 2020 Jan 6.


Introduction: The purpose of this study was to compare operative times, surgical outcomes, resource utilization, and hospital charges before and after the implementation of a sentinel lymph node (SLN) mapping algorithm in endometrial cancer.

Methods: All patients with clinical stage I endometrial cancer were identified pre- (2012) and post- (2017) implementation of the SLN algorithm. Clinical data were summarized and compared between groups. Total hospital charges incurred on the day of surgery were extracted from the hospital financial system for each patient and all charges were adjusted to 2017 US dollars.

Results: A total of 203 patients were included: 71 patients in 2012 and 130 patients in 2017. There was no difference in median age, body mass index, or stage. In 2012, 35/71 patients (49.3%) underwent a lymphadenectomy. In 2017, SLN mapping was attempted in 120/130 patients (92.3%) and at least one SLN was identified in 110/120 (91.7%). Median estimated blood loss was similar between groups (100 mL vs 75 mL, p=0.081). There was a significant decrease in both median operative time (210 vs 171 min, p=0.007) and utilization of intraoperative frozen section (63.4% vs 14.6%, p<0.0001). No significant differences were noted in intraoperative (p=1.00) or 30 day postoperative complication rates (p=0.30). The median total hospital charges decreased by 2.73% in 2017 as compared with 2012 (p=0.96).

Discussion: Implementation of an SLN mapping algorithm for high- and low-risk endometrial cancer resulted in a decrease in both operative time and intraoperative frozen section utilization with no change in surgical morbidity. While hospital charges did not significantly change, further studies are warranted to assess the true cost of SLN mapping.

Keywords: endometrial neoplasms; lymph nodes; sentinel lymph node; uterine neoplasms.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Algorithms*
  • Endometrial Neoplasms / pathology*
  • Endometrial Neoplasms / surgery*
  • Female
  • Hospital Charges
  • Humans
  • Hysterectomy
  • Lymph Node Excision
  • Lymph Nodes / pathology
  • Lymph Nodes / surgery
  • Middle Aged
  • Neoplasm Staging
  • Operative Time
  • Salpingo-oophorectomy
  • Sentinel Lymph Node / pathology
  • Sentinel Lymph Node / surgery
  • Sentinel Lymph Node Biopsy / methods*
  • Treatment Outcome