Abena Kufour

and 3 more

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,‚ÄČLND is beneficial, except for‚ÄČnon-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.