The role of secondary full lymphadenectomy for patients with early-stage endometrial cancer and isolated tumor cells detected on sentinel lymph node biopsy

Sentinel lymph node (SLN) mapping is a surgical technique with high accuracy in detecting metastases while limiting morbidity associated with full lymphadenectomy in endometrial cancer. Recent retrospective data suggests that recurrence risk is low for patients with isolated tumor cells (ITCs). The objective of this study was to describe the pathologic findings, postoperative complications, and outcomes of endometrial cancer patients with ITCs who subsequently underwent a second surgical procedure, full lymph node dissection (LND) following initial staging surgery. All patients with clinically early stage endometrial cancer who underwent planned minimally invasive surgical staging with SLN biopsy demonstrating ITCs at a single institution from 1/1/2017 to 12/31/2020 were identified retrospectively. Six patients with endometrial cancer with ITC who subsequently underwent secondary full LND were identified. Half of patients experienced postoperative complications within 30 days after LND, including persistent thigh numbness, a urinary tract infection, and a presyncopal episode. No patients had a change in stage as a result of subsequent full LND. One patient received no adjuvant therapy, while 83.3 % (5/6) received vaginal brachytherapy. One patient experienced distal recurrence six months after completing brachytherapy, while five remain without evidence of disease on most recent follow-up. In patients who underwent completion lymphadenectomy for ITCs identified during initial surgical staging for endometrial cancer, no additional lymph node metastatic disease was identified. This study supports current data there is a limited role for additional lymph node assessment in patients with early stage endometrial cancer with ITCs identified on SLN biopsy.