Lymphedema and Post-Operative Complications after Sentinel Lymph Node Biopsy versus Lymphadenectomy in Endometrial Carcinomas-A Systematic Review and Meta-Analysis

R.J.A. Helgers, B. Winkens, B.F.M. Slangen, H.M.J. Werner*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

Background: Lymph node dissection (LND) is recommended as staging procedure in presumed low stage endometrial cancer. LND is associated with risk of lower-extremity lymphedema and post-operative complications. The sentinel lymph node (SLN) procedure has been shown to have high diagnostic accuracy, but its effects on complication risk has been little studied. This systematic review compares the risk of lower-extremity lymphedema and post-operative complications in SLN versus LND in patients with endometrial carcinoma. Methods: A systematic search was conducted in PubMed and Cochrane Library. Results: Seven retrospective and prospective studies (total n = 3046 patients) were included. Only three studies reported the odds ratio of lower-extremity lymphedema after SLN compared to LND, which was 0.05 (95% CI 0.01-0.37; p = 0.067), 0.07 (95% CI 0.00-1.21; p = 0.007) and 0.54 (95% CI 0.37-0.80; p = 0.002) in these studies. The pooled odds ratio of any post-operative complications after SLN versus LND was 0.52 (95% CI 0.36-0.73; I-2 = 48%; p < 0.001). For severe post-operative complications the pooled odds ratio was 0.52 (95% CI 0.28-0.96; I-2 = 0%; p = 0.04). Conclusions: There are strong indications that SLN results in a lower incidence of lower-extremity lymphedema and less often severe post-operative complications compared to LND. In spite of the paucity and heterogeneity of studies, direction of results was similar in all studies, supporting the aforementioned conclusion. These results support the increasing uptake of SLN procedures in endometrial cancer.

Original languageEnglish
Article number120
Number of pages16
JournalJournal of Clinical Medicine
Volume10
Issue number1
DOIs
Publication statusPublished - 1 Jan 2021

Keywords

  • cancer
  • diagnosis
  • dissection
  • endometrial cancer
  • impact
  • lower-extremity lymphedema
  • lymph node dissection
  • multicenter
  • outcomes
  • paraaortic lymphadenectomy
  • post-operative complications
  • prevalence
  • risk-factors
  • sentinel lymph node
  • surgery
  • SURGERY
  • PARAAORTIC LYMPHADENECTOMY
  • PREVALENCE
  • CANCER
  • DISSECTION
  • DIAGNOSIS
  • MULTICENTER
  • RISK-FACTORS
  • IMPACT
  • OUTCOMES

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