The role of lymph node dissection in endometrial cancer: a systematic
Background: Surgical staging including lymph node dissection (LND) is
considered the gold standard method of evaluating LN status and guiding
adjuvant therapy in endometrial cancer (EC). The standard surgical
treatment of EC includes systematic LND, which is associated with
morbidity. Consequently, there is debate weighing the risks and benefits
of LND. Objectives: To evaluate the role of LND in all stages of EC.
Search Strategy: Systematic search of MEDLINE up to 9th January 2020
including references of relevant studies. Selection Criteria: Published
literature in English describing LND in EC. Data Collection and
Analysis: 176 articles were screened by title and abstract to select
those describing roles of LND in EC. Main Results: We confirmed the
diagnostic role of LND and the benefits of risk stratifying early-stage
EC patients, despite variations in stratification systems. Low and
high-risk groups have well-established guidelines. The role of LND
remains controversial in intermediate and high-intermediate risk groups.
Sentinel lymph node dissection seems promising to prevent
under-/over-treatment. In all risk groups, the prognostic role of LND is
well-understood however therapeutic use is debatable. In most stages of
advanced EC, LND is beneficial, except for non-bulky nodal disease.
Variation exists in what constitutes adequate LN counts, targets and
surgical methods. Conclusions: International standardisation of the
definition of LND and further adoption of sentinel lymph node algorithms
is required. Future research should investigate the need to stratify for
bulky and non-bulky nodal disease in advanced EC. New RCTs are needed to
guide revaluation of the ESMO-ESGO-ESTRO 2016 guidelines.