Conclusion
In this scoping review, we have critiqued the role of LND, with
variations observed by stage, on both prognostic and therapeutic levels.
There is a lack of international standardisation for both early-stage
risk stratification systems and definition of LND. Whilst definitive
guidelines like ESMO-ESGO-ESTRO 2016 exist for low and high-risk groups,
the role of LND and use of subsequent adjuvant therapy is controversial
for intermediate and high-intermediate risk groups. The mixed nature of
findings suggests the need for a series of prospective randomised
trials. These would need to consider multiple pathological features, in
each sub-group of intermediate risk. In addition, studies validating
adjuvant therapy modalities may confirm the role of LND. SLND provides a
potential solution finding a balance between undertreating and the
adverse risks associated with LND.
Previously it has been widely accepted that LND is diagnostically,
prognostically and therapeutically beneficial in advanced stage EC with
the exception of stage IVB EC where cytoreductive therapy is recommended
instead. However, new evidence has found no benefit for LND in non-bulky
advanced EC. Future research on the need to stratify according to bulky
and non-bulky nodal disease may help to reach a consensus on tailoring
treatment for advanced EC patients.