The Futility of Systematic Lymphadenectomy in Early-Stage Low-grade Endometrial Cancer

Lymphadenectomy is considered an integral part of comprehensive surgical staging of endometrial cancer but debate on the value of lymphadenectomy continues in early-stage endometrial cancer. The aim of our study was to determine the number of node positive patients in clinically early-stage low-grade (G1–G2) endometrioid endometrial cancer. We retro-prospectively analyzed the medical records of 155 women with endometrial pathology coming to the BLK cancer center between January 2015 and December 2017 and studied 60 patients of FIGO grade 1–2 endometrioid endometrial cancer confined to the uterus to determine the nodal positivity. Out of total 60 cases, 2 (3.3%) patients had positive nodes indicating the very low incidence of nodal positivity in clinically uterus confined low-grade endometrioid tumors. Both pelvic and para-aortic lymph nodes were positive in 1 patient. Skip metastases with para-aortic nodal positivity only while pelvic lymph nodes being negative were found in 1 (1.6%) patient. The necessity of comprehensive lymphadenectomy in endometrial cancer remains controversial. Sentinel node mapping can be a reasonably good alternative to strike a balance between systematic lymphadenectomy and no dissection at all in low and intermediate risk endometrial cancer.