Endometrial Cancer and the Role of Lymphadenectomy.

IMPORTANCE: The role of lymph node dissection in early-stage endometrial cancer is highly debated, but staging and prognosis are dependent on knowledge of lymph node metastasis. OBJECTIVE: We sought to review the available data on the use of lymph node assessment in presumed early-stage endometrial cancer. EVIDENCE ACQUISITION: A comprehensive literature review was performed using MEDLINE, the Cochrane Collaborative Database, and PubMed. RESULTS: There is limited retrospective data that suggest a therapeutic benefit to lymphadenectomy. Prospective randomized trials have not shown a benefit to lymphadenectomy in low-risk patients, but found significant morbidity in patients undergoing lymphadenectomy. Selective lymph node assessment should be used in low-risk endometrial cancer. Sentinel lymph node assessment is emerging as a potential strategy for lymph node assessment. CONCLUSIONS AND RELEVANCE: Selective use of lymphadenectomy in early-stage endometrial cancer can reduce the morbidity associated with lymph node dissection without compromising clinical outcomes. Multiple strategies are available including sentinel lymph nodes and risk factor based lymphadenectomy.