[38] However, the definition of a suspicious node was unclear. Also, identification of suspicious lymph nodes without fully opening the retroperitoneal spaces and without palpation (not possible with the minimally invasive approach) is limited and unreliable. Like every effort aimed at decreasing the amount

of surgery and the morbidity of EC treatment, we look at the experimental results on the use of SLN sampling with great interest. Ideally, SLN biopsy could be an effective alternative to Idasanutlin systematic lymphadenectomy. However, available data are still insufficient to define its role in clinical practice. Patients undergoing systematic pelvic and para-aortic lymphadenectomy experience longer operative times and are exposed to greater risk of intraoperative and postoperative complications than patients who have hysterectomy and bilateral salpingo-oophorectomy alone.[6] While some investigations showed that lymph node dissection did not significantly influence complication rates among EC patients,[42, 43] at Mayo Clinic, we observed that retroperitoneal staging,

including para-aortic lymphadenectomy, Ulixertinib order increases morbidity in patients with EC.[44] Similarly, results from the ASTEC trial and the Italian collaborative trial indicated that women who underwent lymphadenectomy had a significantly higher risk of surgically related morbidity and lymphatic complications than those who had hysterectomy plus bilateral salpingo-oophorectomy alone (relative risk [RR], 3.72; 95% CI, 1.04–13.27; and RR, 8.39; 95% CI, 4.06–17.33, for risk of surgical and lymphatic complications, respectively).[6, 7, 45] However, it is important to note that the introduction of minimally invasive lymph node dissection may have reduced the complication rate of lymphadenectomy.[46-48] The impact of lymphadenectomy on long-term QOL in EC patients is not clear.

Recently, a Dutch population-based analysis[49] evaluated the health-related QOL and symptoms following pelvic lymphadenectomy and radiation therapy (alone or in combination) Tenofovir versus no adjuvant therapy in patients with FIGO stage I and II EC. Lymphedema, gastrointestinal tract symptoms, diarrhea, back and pelvic pain, and muscular joint pain were the most commonly reported symptoms. The authors showed that, despite different symptom patterns, in patients who had pelvic lymphadenectomy (e.g. lymphedema), radiotherapy (e.g. diarrhea) or both, no clinical differences in overall QOL were observed compared with women not receiving adjuvant therapy, lymphadenectomy or both.[49] At Mayo Clinic, we analyzed the related surgical costs of lymphadenectomy in our low-risk EC population and reported that lymphadenectomy increased the median 30-day cost of care by approximately $US 4500 per patient.