Interpretation
Prior to introducing SLNB as an alternative to full pelvic and
paraaortic lymphadenectomy, it was important to first demonstrate that
lymphadenectomy does not provide an independent therapeutic benefit. The
CONSORT and ASTEC trials, are often considered together and were
fundamental in demonstrating that complete lymphadenectomy is not
associated with an overall survival benefit in women with endometrial
cancer [8, 9]. Despite this evidence, many practicing gynecologic
oncologists continue to perform full lymph node dissections at time of
surgical staging for endometrial cancer. In 2015, only 28.6% of
gynecologic oncologists participating in a survey conducted by the
society of gynecologic oncology performed SLN mapping for their
endometrial cancer patients, thus continuing to reflect a wide range of
provider–specific practices [4]. More recent studies generated by
large cancer specialty centers report overall recurrence rates as low as
1.4-9.4% in SLN cohorts with stage I endometrial cancer [10, 11].
In one such study, one-year disease free recurrence rates among patients
who underwent SLN mapping were similar to those who underwent complete
lymphadenectomy, with a 9.4% recurrence rate in the SLN group and a
14% recurrence in the complete LND cohort. Additionally, SLN cohorts
were found to have improved pelvic side wall recurrence free survival
compared to patients undergoing complete pelvic lymph node dissection
[12]. Our data further demonstrate that cancer-specific outcomes are
not affected by the omission a full lymph node dissection, with no
recurrences in our cohort. Taken together, this data supports the
growing consensus that SLN mapping can be implemented as an appropriate
balance between nodal assessment and the morbidities associated with
complete pelvic and paraaortic lymphadenectomy, while increasing the
detection rate of clinically significant metastatic disease.