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.