Introduction
Uterine endometrial carcinoma (EC) is the most common malignancy of the
female reproductive tract in developed countries(1),
with approximately 380,000 new cases worldwide in
2018(2).
Most patients present with early-stage (stage I/II)(3)endometrioid EC(4). In contrast, advanced cancer
(stage III/IV)(5) accounts for more than 50% of
uterine-related deaths(6). In order to guide
management, a preoperative assessment is mandatory. This includes a full
clinical history, pelvic examination, ultrasonography and endometrial
biopsy or curettage to determine histotype and grade. Additionally,
advanced imaging is recommended to assess myometrial
invasion(5).
Lymph node (LN) metastasis is the most common site of extrauterine
spread in EC(7) and contributes to a worse survival
outcome. LN involvement is the most important prognostic factor in EC,
especially for early clinical stages(8). Due to their
high specificities(9), specialised imaging techniques
such as pelvic CT, MRI and PET scan are recommended to determine LN
status(5). However, detection rates of node positive
disease and availability to provide imaging to all early-stage EC
patients remains variable between centres(10). Hence,
imaging alone is not sufficient for the surgical staging
process(11).
The standard treatment of EC is total hysterectomy, bilateral
salpingo-oophorectomy and in some cases systematic lymph node dissection
(LND). LND is the surgical removal of lymph nodes(12).
Complete surgical staging, including LND is considered the gold standard
method of evaluating lymph node status(7,13,14). This
can be used to assess patient prognosis and guide treatment decisions.
LND has been demonstrated to have a possible diagnostic, prognostic and
therapeutic benefit in patients with EC(12). However,
LND is associated with surgically related
morbidity(12), leading to studies considering whether
LND is required.
It is evident from the breadth of the literature that clinicians
worldwide must balance the benefits and harms of LND. Therefore, we aim
to conduct a scoping review evaluating the roles of LND in all stages of
EC particularly addressing the key controversies.