TOPLINE

Between 2018 and 2022, sentinel-based lymph node procedures accounted for more than 60% of all nodal staging in endometrial cancer at six German university hospitals. Primary systematic lymphadenectomy declined from 30.3% in 2018 to 17.9% in 2022.

METHODOLOGY

• Researchers conducted a multicenter retrospective cohort study as part of the E-PEC project, analyzing 644 patients (median age, 63 years) who underwent primary surgical treatment for newly diagnosed endometrial cancer at six German university hospitals between 2018 and 2022.
• Lymph node procedures were categorized as mutually exclusive at the patient level and included primary systematic lymphadenectomy, secondary systematic lymphadenectomy, sentinel-guided lymphadenectomy, sentinel-node biopsy (SLNB), and targeted compartmental lymphadenectomy (TCL).
• Overall, 62.4% of patients underwent lymph node surgery with evaluable lymph node tissue; an additional 0.6% had attempted nodal procedures without retrievable tissue, and 37.0% had no lymph node surgery performed.
• Researchers analyzed temporal trends in lymph node surgery types across the study period, with demographic and clinical characteristics including age, body mass index (BMI), tumor stage, and histologic parameters collected from the E-PEC database.

TAKEAWAY

• Among patients undergoing lymph node surgery with evaluable tissue, 61.4% received sentinel-based procedures, while 38.6% underwent systematic lymphadenectomy. 
• Targeted compartmental lymphadenectomy was the most common sentinel-based approach, performed in 64.8% of sentinel procedures, while primary systematic lymphadenectomy accounted for 89.0% of systematic procedures. 
• The proportion of primary systematic lymphadenectomy decreased significantly from 30.3% in 2018 to 17.9% in 2022 (P < .05), while less radical procedures such as SLNB and TCL increased significantly over the same period (P < .05). 
• Robot-assisted laparoscopic hysterectomy was the most common surgical approach (33.4%), followed by conventional laparoscopy (23.0%), with minimally invasive techniques increasing and open approaches declining between 2018 and 2022.

IN PRACTICE

”In this multicenter retrospective cohort, we observed a temporal increase in sentinel-based lymph node procedures and a decrease in systematic lymphadenectomy between 2018 and 2022,“ the authors wrote. “These findings describe evolving surgical practice patterns; however, causal interpretation is limited by missing data, lack of adjusted analyses, and potential center-specific effects.”

SOURCE

The study was led by B. Eser, Department of Gynecology and Obstetrics, University Hospital of Essen, Medical Faculty of the University of Duisburg-Essen in Essen, Germany. It was published online on July 28, 2026, in Archives of Gynecology and Obstetrics.

LIMITATIONS

The retrospective design introduces potential selection bias and confounding. A substantial proportion of patients had missing nodal status (37.6%), which limits interpretation of nodal staging patterns. No adjusted analyses were performed to account for differences in patient characteristics or center-specific effects. Molecular classification data were not consistently available across centers. Detailed data on sentinel lymph node mapping techniques, including tracer type, detection rates, and laterality, were not consistently available.

DISCLOSURES

The study received open access funding enabled and organized by Projekt DEAL. Several authors reported honoraria, consulting fees, or research support from pharmaceutical and medical device companies, including AstraZeneca, MSD, Pfizer, Roche, Novartis, Intuitive Surgical, and others. Full author disclosures are reported in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.