Impact of Sentinel Lymph Node Biopsy Versus Complete Lymphadenectomy on Quality of Life and Lymphedema in Early-Stage Endometrial Cancer: A Prospective Cohort Study

Impact of Sentinel Lymph Node Biopsy Versus Complete Lymphadenectomy on Quality of Life and Lymphedema in Early-Stage Endometrial Cancer: A Prospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Impact of Sentinel Lymph Node Biopsy Versus Complete Lymphadenectomy on Quality of Life and Lymphedema in Early-Stage Endometrial Cancer: A Prospective Cohort Study Anna Torrent, Joana Amengual, Angela Ruiz, Aina Serra, Laura Fuertes, and 5 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6477370/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Purpose This study aimed to compare health-related quality of life (HRQoL), overall health perception (oHP), and the incidence of lower-limb lymphedema in early-stage endometrial cancer patients undergoing either sentinel lymph node (SLN) biopsy or complete pelvic lymphadenectomy (CL). Methods In this prospective, single-center study, 97 patients diagnosed with early-stage endometrial cancer underwent either SLN biopsy alone (n=47) or SLN mapping followed by CL (n=50). HRQoL and oHP were assessed using the EQ-5D-3L and a 0–100 visual analogue scale at baseline and six months postoperatively. Lymphedema was evaluated using the Self-report Lower-Extremity Lymphedema Questionnaire (LELQ). Results Patients in the SLN group reported significantly higher oHP (median 85 vs. 70; p =0.001) and better HRQoL scores (median 5 vs. 7; p =0.001) compared to the CL group. Symptomatic lymphedema was more frequent in the CL group (34.4% vs. 7.0%; p =0.002). No significant differences were observed in intraoperative or postoperative complications between the groups. Conclusion SLN biopsy was associated with improved patient-reported outcomes and a lower incidence of lymphedema, with similar surgical safety compared to complete lymphadenectomy. These findings support SLN biopsy as a preferred nodal staging technique in early-stage endometrial cancer. quality of life endometrial cancer Lymphedema Sentinel Lymph node cancer survivors Figures Figure 1 Figure 2 Figure 3 What does this study add to the clinical work Sentinel lymph node biopsy in early-stage endometrial cancer significantly improves quality of life and reduces the risk of symptomatic lymphedema compared to complete lymphadenectomy. These findings support current guidelines favoring SLN biopsy and highlight its benefit not only in surgical outcomes but also in long-term patient well-being. Introduction Endometrial cancer is the most common gynecologic malignancy in high-income countries, with a 132% increase in incidence over the past 30 years ( 1 ). Most cases are diagnosed at an early stage, and overall survival exceeds 90% in FIGO stage I disease ( 2 ). Although the majority of cases are diagnosed in women over 55 years old, it is important to note that approximately 14% of cases occur in younger women, under the age of 40, at the time of diagnosis ( 3 ). As a result, long-term survivorship and quality of life (QoL) have become increasingly important considerations in treatment planning. Pelvic lymph node assessment remains a standard part of surgical staging. However, randomized trials have shown no survival benefit from systematic lymphadenectomy in early-stage disease, raising concerns about overtreatment and morbidity ( 4 )( 5 ). In recent years, sentinel lymph node (SLN) biopsy has emerged as a less invasive alternative, offering adequate staging with reduced surgical complications. Leading guidelines now endorse SLN biopsy as a preferred option, particularly in low- and intermediate-risk cases ( 6 )( 7 ). While previous studies have highlighted the reduced risk of lymphedema with SLN biopsy, few have examined its broader impact on patient-reported outcomes such as health-related quality of life and overall health perception. Moreover, prospective data comparing SLN biopsy and complete lymphadenectomy (CL) in terms of these outcomes remain limited. The aim of this study was to assess the impact of SLN biopsy versus CL on QoL, perceived health status, and symptomatic lymphedema in patients undergoing surgery for early-stage endometrial cancer. Our findings may further support the shift toward less invasive staging techniques that prioritize not only oncologic safety but also long-term survivorship. Methods Study Design: This was a prospective, single-center cohort study conducted at a tertiary hospital in Palma, Spain, between January 2019 and November 2022. The study was approved by the local ethics committee (CEI-IB Ref. IB 4103/20 PI), and all patients provided written informed consent prior to participation. Participants: Patients with histologically confirmed early-stage endometrial adenocarcinoma (FIGO stage I–II), without evidence of extrauterine disease on preoperative imaging, were eligible. Exclusion criteria included prior pelvic or abdominal radiotherapy, contraindication to surgery or tracer injection (ICG/Tc99m), recurrence during follow-up, or death during the study period. Table 1 Inclusion and exclusion criteria Inclusion Criteria: • Histological diagnosis of endometrial adenocarcinoma. • Diagnosis of early-stage disease (FIGO stage I-II) confirmed by imaging studies. • Absence of extrauterine disease. Exclusion Criteria : • Contraindication for surgical treatment. • Contraindication for ICG and/or Tc99m injection. • Patients with a history of pelvic or abdominal radiotherapy. • Patients experiencing recurrence during the study period. • Patients who die during the study, either due to the disease or other medical conditions Patients were allocated into two groups based on institutional practice patterns during the study period: SLN group : Patients underwent pelvic sentinel lymph node biopsy only. CL group : Patients underwent SLN biopsy followed by complete pelvic lymphadenectomy, as part of the SLN technique validation phase at our institution. Para-aortic lymphadenectomy was performed in cases of intraoperative SLN involvement or high-risk features, following ESGO/ESTRO/ESP guidelines. Surgical Approach All procedures were performed using minimally invasive techniques (laparoscopy or robot-assisted surgery), and choice of approach was based on surgeon preference and patient characteristics. Outcome Measures Patients completed three validated questionnaires at baseline and six months postoperatively: HRQoL : EQ-5D-3L questionnaire (score range: 5–15; higher scores indicate greater impact on QoL) Overall Health Perception (oHP) : Visual analogue scale from 0 (worst) to 100 (best) Lymphedema : Self-report Lower-Extremity Lymphedema Questionnaire (LELQ); scores ≥ 5 were considered positive Lymphocele diagnosis was confirmed by CT scan at six months in symptomatic patients. Statistical Analysis Descriptive statistics were used to summarize baseline characteristics. Group comparisons were made using the Mann-Whitney U test for continuous variables and the Chi-square or Fisher's exact test for categorical variables. Multivariate logistic regression models were used to adjust for potential confounders, including surgical approach, para-aortic lymphadenectomy, and adjuvant treatment. A p-value < 0.05 was considered statistically significant. Analyses were performed using IBM SPSS Statistics v.26. Table 2 Clinical and Demographic Characteristics of the Study Population (n = 97) Total n = 97(%) CL + SLN (%) (n = 50) SLN (n = 47) P Age 62.0 (56.0–71.0) 64.5 (56.0–74.0) 61.0 (56.0–70.0) 0.392 BMI 30.0 (25.0–37.0) 30.0 (25.0–36.0) 30.0 (25.0–37.0) 0,.54 BMI 30 53 (54.6%) 26 (52%) 27 (57.4%) Surgical approach Laparoscopic 32 (33%) 26 (52%) 6 (12.8%) 0,000 Robotics 65 (67.0%) 24 (48.0%) 41 (87.2%) Histological type Endometrioid Serous Clear cell Carcinosarcoma Others 71 (73.2%) 13 (13.4%) 2 (2.1%) 6 (6.2%) 5 (5.2%) 35 (70%) 10 (20%) 1 (2%) 4 (8.0%) 0 (0.0%) 36 (76.6%) 3 (6.4%) 1 (2.1%) 2 (4.3%) 5 (10.6%) NA ESGO/ESTRO/ESP Risk group Low Intermediate High-intermediate 37 (38.1%) 29 (29.9%) 31 (31.3%) 16 (32.0%) 10 (20%) 24 (48%) 21 (44.7%) 19 (40.4%) 7 (14.9%) NA Adjuvant Therapy No Yes 37 (38.9%) 60 (61.8%) 14 (28%) 36 (72%) 24 (51.1%) 23 (48.9%) 0.018 Para-aortic lymphadenectomy No Yes 57 (58.8%) 40 (41.2%) 19 (38%) 31 (62%) 38 (80.9%) 9 (19.1%) 0,000 BMI: Body Mass Index; ESGO/ESTRO/ESP: European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology; European Society of Pathology; CL: Complet Lymphadenectomy; SLN: Sentinel Lymph Node biopsy Results Study Population A total of 97 patients were included: 50 underwent complete lymphadenectomy (CL group) and 47 underwent sentinel lymph node biopsy alone (SLN group). Baseline characteristics were similar between groups regarding age, body mass index (BMI), histologic type, and ESGO/ESTRO/ESP risk classification [6](Table 1 ). The surgical approach differed significantly: 87.2% of patients in the SLN group underwent robotic surgery compared to 48% in the CL group ( p < 0.001). Quality of Life and Health Perception At six months, patients in the SLN group had significantly better HRQoL scores (median 5 vs. 7; p = 0.001) and higher overall health perception scores (median 85 vs. 70; p = 0.001) compared to the CL group (Fig. 1 ). Additionally, the SLN group showed greater stability in oHP over time, while the CL group experienced a decline (median change: 0 vs. -7.5; p = 0.011). Lymphedema and Lymphocele Symptomatic lymphedema (LELQ score ≥ 5) was reported in 34.4% of patients in the CL group versus 7.0% in the SLN group ( p = 0.002) (Fig. 2 ). Three cases of lymphocele (6%) were identified in the CL group; none occurred in the SLN group. Two of the lymphocele cases required interventional drainage. Multivariate analysis confirmed a significantly lower risk of lymphedema in the SLN group (OR 0.096, 95% CI 0.020–0.459; p = 0.003) and lower odds of deteriorated health perception (OR 0.208, 95% CI 0.063–0.688; p = 0.010). Surgical Morbidity Intraoperative complications occurred only in the CL group (3 cases; 6.0%) and included one bladder injury, one intestinal injury, and one anesthesia-related event. Postoperative complications occurred in 11 patients (11.3%), with no significant difference between groups (12.0% CL vs. 10.6% SLN; p = 0.833) (Table 3 ). Four patients developed obturator nerve neuropathy (two in each group), all attributed to thermal injury. Three resolved with rehabilitation, while one case had persistent mild symptoms at six months. Impact of BMI, Para-aortic Lymphadenectomy, and Adjuvant Treatment Obesity (BMI ≥ 30) was not significantly associated with worse HRQoL or oHP outcomes. Para-aortic lymphadenectomy was performed more frequently in the CL group (62% vs. 19.1%; p < 0.001) but was not associated with increased risk of lymphedema or reduced QoL in multivariate models. Adjuvant therapy was more common in the CL group (73.5% vs. 50%; p = 0.018). Among patients with symptomatic lymphedema, 80% had received adjuvant therapy, although this was not statistically significant ( p = 0.093). Table 3 Intra- and post-operative complications Complications Total CL + SLN, n (%) SLN, n (%) p Intraop. Complications 3 (3.1%) 3 (6.0%) 0 (0%) 0.243 Bladder injury 1 1 0 Intestinal injury 1 1 0 Anaesthetic complication 1 1 0 Post-op. Complications 11 (11.3%) 6 (12.0%) 5 (10.6%) 0.833 Surgical wound infection 4 2 2 Over-infected Lymphocele 2 2 0 Obturator nerve neuropathy 4 2 2 Fever 1 0 1 Intraop: intraoperative; Post-op: Postoperative. CL: complete Lymphadenectomy; SLN: Sentinel Lymph node biopsy Discussion This prospective cohort study demonstrates that sentinel lymph node (SLN) biopsy in early-stage endometrial cancer is associated with improved patient-reported outcomes, including better health-related quality of life (HRQoL), higher overall health perception (oHP), and a lower incidence of symptomatic lower-limb lymphedema, compared to complete pelvic lymphadenectomy (CL). These findings reinforce current clinical guidelines that advocate for SLN biopsy as a less invasive and more patient-centered approach to surgical staging. Despite the growing evidence of SLN mapping in endometrial cancer, many studies have shown a lower incidence of Lymphedema, bit few prospective studies analyze the impact on quality of life (QoL). Geppert et al. reported a lower incidence of leg lymphedema with SLN (1.3%) versus systematic lymphadenectomy (18.1%) (8) but did not assess the impact on QoL. Similarly, our study observed a significantly lower rate of symptomatic lymphedema in the SLN group (7.0%) compared to the CL group (34.4%). Importantly, we also found a favourable impact on overall quality of life and self-perceived health, outcomes that are less frequently evaluated in the literature. Wedin et al. (9) found that generic HRQoL was not significantly affected by lymphadenectomy but did report lower limb lymphedema-specific QoL deterioration In contrast, our results show significant differences in both generic and specific patient-reported outcomes. The inclusion of validated instruments such as EQ-5D-3L and LELQ strengthens the reliability of these findings. While para-aortic lymphadenectomy and adjuvant therapy were more frequently performed in the CL group, multivariate analyses suggest that the type of nodal staging technique (SLN vs. CL) had the greatest influence on QoL and lymphedema risk. These results emphasize the importance of minimizing surgical morbidity without compromising oncologic safety. Other risk factors, such as obesity and age, can influence QoL scales. The study by Karatasli et al. investigated the impact of BMI on the QoL of patients with endometrial cancer and concluded that the group with morbid obesity had poorer physical functioning than the group without morbid obesity (p 30 showed a worsening of HR-QoL (62.9% vs 37.1%; p=0.308) and worse oHP (57.9% vs 42.1%; p=0.872). The majority of lymphedemas (80%) and lymphoceles (66.7%) were diagnosed in patients with a BMI <30, but there were no differences in the LELQ, which reflects lymphedema symptoms. Pelvic radiation has been suggested as an important risk factor for lymphedema although other authors did not find post-operative radiation to be a predictive factor for lymphedema In our series, after multivariate analysis, 80% (12 patients) of those with an LELQ score >5 (symptomatic lymphedema) had received complementary treatment (brachytherapy/external radiotherapy with or without chemotherapy), while only 20% of patients who had not received complementary treatment scored positive on the LELQ. These differences were not statistically significant (p=0.093), likely due to the small number of cases in both groups. Our study has several strengths. It is one of the few prospective studies comparing SLN biopsy and CL with a focus on quality of life, using validated patient-reported outcomes and balanced group sizes, unlike other studies ((11)(12). Limitations include its single-center design and the absence of specific assessment of sexual function (12) or long-term follow-up beyond six months. Additionally, the impact of confounding comorbidities such as osteoarthritis or cardiovascular disease was not formally evaluated. From a clinical perspective, these results support the routine use of SLN biopsy for staging in early-stage endometrial cancer. Beyond its diagnostic value, this technique offers meaningful benefits in survivorship outcomes, particularly in minimizing physical and psychological burdens associated with postoperative complications like lymphedema. In conclusion, sentinel lymph node biopsy provides a less invasive staging option in early-stage endometrial cancer, offering significant improvements in patient-reported quality of life and a lower risk of symptomatic lymphedema compared to complete lymphadenectomy. These findings support the adoption of SLN biopsy as the standard approach in appropriate patients, contributing not only to accurate staging but also to enhanced long-term well-being and survivorship care. Declarations Author contributions : A.T. and J.A. conceived and designed the study. A.T., A.S., A.R., and L.F. collected and curated the data. A.T. and A.R. performed the statistical analysis. A.T, J.A., M.R., J.R., and C.S. contributed to patient care and surgical procedures. P.R. and O.C. provided methodological oversight and critical revision of the manuscript. A.T. drafted the manuscript, and all authors reviewed and approved the final version. Funding : This research received no external funding. Data availability : The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request. Conflict of interests: The authors declare no relevant financial or non-financial conflicts of interest. Ethical approval: The study was approved by the Ethics Committee of the Balearic Islands, Spain (CEI-IB Ref. IB 4103/20 PI) and conducted in accordance with the Declaration of Helsinki. Consent to participate: Informed consent was obtained from all the individual participants included in the study. Acknowledgments : We would like to thank Aina Millan (IdISBa) for her support with statistical analysis, and all patients who kindly agreed to participate in this study. References Crosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022 Apr 9;399(10333):1412–28. Miller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409–36. “The Statistical Office of the European Union.” Mortality and life expectancy statistics [Internet]. Eurostat. 2017. Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php/Mortality_and_life_expectancy_statistics ASTEC study group T writing committee on behalf of the A study, Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England) [Internet]. 2009 Jan 10 [cited 2019 Mar 31];373(9658):125–36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19070889 Panici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. JNCI J Natl Cancer Inst [Internet]. 2008 Dec 3 [cited 2024 Oct 20];100(23):1707–16. Available from: https://dx.doi.org/10.1093/jnci/djn397 Concin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12–39. Holloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol [Internet]. 2017;146(2):405–15. Available from: http://dx.doi.org/10.1016/j.ygyno.2017.05.027 Geppert B, Lönnerfors C, Bollino M, Persson J. Sentinel lymph node biopsy in endometrial cancer—Feasibility, safety and lymphatic complications. Gynecol Oncol [Internet]. 2018;148(3):491–8. Available from: https://doi.org/10.1016/j.ygyno.2017.12.017 Wedin M, Stålberg K, Marcickiewicz J, Ahlner E, Åkesson, Lindahl G, et al. Impact of lymphadenectomy and lymphoedema on health-related quality of life 1 year after surgery for endometrial cancer. A prospective longitudinal multicentre study. BJOG An Int J Obstet Gynaecol. 2022;129(3):450–60. Karataşlı V, Can B, Çakır İ, Erkılınç S, Kuru O, Gökçü M, et al. Life quality of endometrioid endometrial cancer survivors: a cross-sectional study. J Obstet Gynaecol (Lahore) [Internet]. 2021 [cited 2024 Nov 3];41(4):621–5. Available from: https://www.tandfonline.com/doi/abs/10.1080/01443615.2020.1787969 Goncalves BT, Dos Reis R, Ribeiro R, Moretti-Marques R, Schamme FK, Oliveira GS, et al. Does sentinel node mapping impact morbidity and quality of life in endometrial cancer? Int J Gynecol Cancer. 2023;33(10):1548–56. García-Pineda V, Hernández A, Garrido-Mallach S, Rodríguez-González E, Alonso-Espías M, Gracia M, et al. Sentinel Lymph Node Impact on the Quality of Life of Patients with Endometrial Cancer. J Pers Med. 2023;13(5). Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6477370","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":451891449,"identity":"1452968e-a573-40ad-a97b-2d584e4c7a52","order_by":0,"name":"Anna Torrent","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Anna","middleName":"","lastName":"Torrent","suffix":""},{"id":451891453,"identity":"ec551d50-f2e6-4632-9477-187e68f2fe75","order_by":1,"name":"Joana Amengual","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA/UlEQVRIiWNgGAWjYBACxgYUboENAwMzD0laDNIIa0EDBoeBBAEtzO3Nzx78YLCL5pduvybxw+C8vXw77wGGD3/wOKznmLlhD0Ny7sw5Z8okewxuJ244zJfAOLMNj5YZCWYSPAzMuRtu5KRJ8BjcTjBg5jFg5m3ApyX9m+Qfhvrc/UAtkn8MztnLNwO1/MHnsBk5ZtI8DIdzN0ikH5PmMTjA2HAYqIWBDZ9fzpRJyxgcz51xI4fZWsYgGeyXg714/GLY3r5N8k1FdW7/jPSHN99U2NnL9589+OAHHocZgv1pACJ4DOCiB3BrYGCQRzDZH+BTOApGwSgYBSMYAAADCk62s39U+gAAAABJRU5ErkJggg==","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":true,"prefix":"","firstName":"Joana","middleName":"","lastName":"Amengual","suffix":""},{"id":451891454,"identity":"7fe172ce-c186-4cd8-9416-e7791c1a41c5","order_by":2,"name":"Angela Ruiz","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Angela","middleName":"","lastName":"Ruiz","suffix":""},{"id":451891455,"identity":"1f1d73be-e41c-425d-992a-7f04f1af81c7","order_by":3,"name":"Aina Serra","email":"","orcid":"","institution":"Hospital Comarcal de Inca","correspondingAuthor":false,"prefix":"","firstName":"Aina","middleName":"","lastName":"Serra","suffix":""},{"id":451891456,"identity":"1361fff4-b182-4170-a33d-7e1702c7478e","order_by":4,"name":"Laura Fuertes","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Laura","middleName":"","lastName":"Fuertes","suffix":""},{"id":451891457,"identity":"8ed5d8ff-289a-4073-961c-e130aece4daf","order_by":5,"name":"Catalina Maria Sampol","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Catalina","middleName":"Maria","lastName":"Sampol","suffix":""},{"id":451891460,"identity":"8a4f08ea-7eb7-4ebb-9577-f75c8e617979","order_by":6,"name":"Mario Ruiz","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Mario","middleName":"","lastName":"Ruiz","suffix":""},{"id":451891464,"identity":"aadc1b26-0523-41f7-803d-abb80e1cdb7b","order_by":7,"name":"Jorge Rioja","email":"","orcid":"","institution":"Hospital Universitari Son Espases","correspondingAuthor":false,"prefix":"","firstName":"Jorge","middleName":"","lastName":"Rioja","suffix":""},{"id":451891465,"identity":"a2bdc54b-2305-4ba4-9b7c-6e6381c976af","order_by":8,"name":"Pilar Roca","email":"","orcid":"","institution":"Institut d’Investigació Sanitària de les Illes Balears","correspondingAuthor":false,"prefix":"","firstName":"Pilar","middleName":"","lastName":"Roca","suffix":""},{"id":451891466,"identity":"82867d30-d3c8-4bd2-8504-6785922b6f09","order_by":9,"name":"Octavi Cordoba","email":"","orcid":"","institution":"Institut d’Investigació Sanitària de les Illes Balears","correspondingAuthor":false,"prefix":"","firstName":"Octavi","middleName":"","lastName":"Cordoba","suffix":""}],"badges":[],"createdAt":"2025-04-18 08:23:22","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6477370/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6477370/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":82352782,"identity":"18e18452-2439-49c1-9b86-d1997730f8e3","added_by":"auto","created_at":"2025-05-09 11:02:58","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":75153,"visible":true,"origin":"","legend":"\u003cp\u003eFlowchart of participants.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-6477370/v1/3c6b888345262dad6d8c1077.png"},{"id":82352783,"identity":"3edca4ea-6f57-4b0a-b064-d2b26e4bc9f5","added_by":"auto","created_at":"2025-05-09 11:02:58","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":46774,"visible":true,"origin":"","legend":"\u003cp\u003eBox Plot Health Related Quality of life (HR-QoL) and Overall Health Perception (oHP). Blue: 0 months; Red: 6 months\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-6477370/v1/133becdd340fa4a90f4e07c7.png"},{"id":82354700,"identity":"ebdf38a6-8f74-47c7-b154-c84d5b99e723","added_by":"auto","created_at":"2025-05-09 11:10:58","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":95306,"visible":true,"origin":"","legend":"\u003cp\u003eBox Plot Self-report Lower-Extremity Lymphedema Questionnaire (LELQ)\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-6477370/v1/f779dd761d0a784fd1e58446.png"},{"id":84731883,"identity":"73e957b3-b71c-4f79-8884-b26c451d5296","added_by":"auto","created_at":"2025-06-16 17:16:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":977086,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6477370/v1/80895cfd-8235-477a-9c76-412b9a5348d1.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Impact of Sentinel Lymph Node Biopsy Versus Complete Lymphadenectomy on Quality of Life and Lymphedema in Early-Stage Endometrial Cancer: A Prospective Cohort Study","fulltext":[{"header":"What does this study add to the clinical work","content":"\u003cp\u003eSentinel lymph node biopsy in early-stage endometrial cancer significantly improves quality of life and reduces the risk of symptomatic lymphedema compared to complete lymphadenectomy. These findings support current guidelines favoring SLN biopsy and highlight its benefit not only in surgical outcomes but also in long-term patient well-being.\u003c/p\u003e"},{"header":"Introduction","content":"\u003cp\u003eEndometrial cancer is the most common gynecologic malignancy in high-income countries, with a 132% increase in incidence over the past 30 years (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). Most cases are diagnosed at an early stage, and overall survival exceeds 90% in FIGO stage I disease (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). Although the majority of cases are diagnosed in women over 55 years old, it is important to note that approximately 14% of cases occur in younger women, under the age of 40, at the time of diagnosis (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). As a result, long-term survivorship and quality of life (QoL) have become increasingly important considerations in treatment planning.\u003c/p\u003e \u003cp\u003ePelvic lymph node assessment remains a standard part of surgical staging. However, randomized trials have shown no survival benefit from systematic lymphadenectomy in early-stage disease, raising concerns about overtreatment and morbidity (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). In recent years, sentinel lymph node (SLN) biopsy has emerged as a less invasive alternative, offering adequate staging with reduced surgical complications. Leading guidelines now endorse SLN biopsy as a preferred option, particularly in low- and intermediate-risk cases (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e)(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eWhile previous studies have highlighted the reduced risk of lymphedema with SLN biopsy, few have examined its broader impact on patient-reported outcomes such as health-related quality of life and overall health perception. Moreover, prospective data comparing SLN biopsy and complete lymphadenectomy (CL) in terms of these outcomes remain limited.\u003c/p\u003e \u003cp\u003eThe aim of this study was to assess the impact of SLN biopsy versus CL on QoL, perceived health status, and symptomatic lymphedema in patients undergoing surgery for early-stage endometrial cancer. Our findings may further support the shift toward less invasive staging techniques that prioritize not only oncologic safety but also long-term survivorship.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eStudy Design: This was a prospective, single-center cohort study conducted at a tertiary hospital in Palma, Spain, between January 2019 and November 2022. The study was approved by the local ethics committee (CEI-IB Ref. IB 4103/20 PI), and all patients provided written informed consent prior to participation.\u003c/p\u003e\n\u003cp\u003eParticipants: Patients with histologically confirmed early-stage endometrial adenocarcinoma (FIGO stage I\u0026ndash;II), without evidence of extrauterine disease on preoperative imaging, were eligible. Exclusion criteria included prior pelvic or abdominal radiotherapy, contraindication to surgery or tracer injection (ICG/Tc99m), recurrence during follow-up, or death during the study period.\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eInclusion and exclusion criteria\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"1\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eInclusion Criteria:\u003c/p\u003e\n \u003cp\u003e\u0026bull; Histological diagnosis of endometrial adenocarcinoma.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Diagnosis of early-stage disease (FIGO stage I-II) confirmed by imaging studies.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Absence of extrauterine disease.\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e\u003cstrong\u003eExclusion Criteria\u003c/strong\u003e:\u003c/p\u003e\n \u003cp\u003e\u0026bull; Contraindication for surgical treatment.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Contraindication for ICG and/or Tc99m injection.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Patients with a history of pelvic or abdominal radiotherapy.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Patients experiencing recurrence during the study period.\u003c/p\u003e\n \u003cp\u003e\u0026bull; Patients who die during the study, either due to the disease or other medical conditions\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003ePatients were allocated into two groups based on institutional practice patterns during the study period:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eSLN group\u003c/strong\u003e: Patients underwent pelvic sentinel lymph node biopsy only.\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eCL group\u003c/strong\u003e: Patients underwent SLN biopsy followed by complete pelvic lymphadenectomy, as part of the SLN technique validation phase at our institution.\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003ePara-aortic lymphadenectomy was performed in cases of intraoperative SLN involvement or high-risk features, following ESGO/ESTRO/ESP guidelines.\u003c/p\u003e\n\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\n \u003ch2\u003eSurgical Approach\u003c/h2\u003e\n \u003cp\u003eAll procedures were performed using minimally invasive techniques (laparoscopy or robot-assisted surgery), and choice of approach was based on surgeon preference and patient characteristics.\u003c/p\u003e\n\u003c/div\u003e\n\u003ch3\u003eOutcome Measures\u003c/h3\u003e\n\u003cp\u003ePatients completed three validated questionnaires at baseline and six months postoperatively:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eHRQoL\u003c/strong\u003e: EQ-5D-3L questionnaire (score range: 5\u0026ndash;15; higher scores indicate greater impact on QoL)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eOverall Health Perception (oHP)\u003c/strong\u003e: Visual analogue scale from 0 (worst) to 100 (best)\u003c/p\u003e\n \u003c/li\u003e\n \u003cli\u003e\n \u003cp\u003e\u003cstrong\u003eLymphedema\u003c/strong\u003e: Self-report Lower-Extremity Lymphedema Questionnaire (LELQ); scores\u0026thinsp;\u0026ge;\u0026thinsp;5 were considered positive\u003c/p\u003e\n \u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eLymphocele diagnosis was confirmed by CT scan at six months in symptomatic patients.\u003c/p\u003e\n\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\n \u003ch2\u003eStatistical Analysis\u003c/h2\u003e\n \u003cp\u003eDescriptive statistics were used to summarize baseline characteristics. Group comparisons were made using the Mann-Whitney U test for continuous variables and the Chi-square or Fisher\u0026apos;s exact test for categorical variables. Multivariate logistic regression models were used to adjust for potential confounders, including surgical approach, para-aortic lymphadenectomy, and adjuvant treatment. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant. Analyses were performed using IBM SPSS Statistics v.26.\u003c/p\u003e\n \u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\" class=\"fr-table-selection-hover\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eClinical and Demographic Characteristics of the Study Population (n\u0026thinsp;=\u0026thinsp;97)\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"7\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003cp\u003en\u0026thinsp;=\u0026thinsp;97(%)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eCL\u0026thinsp;+\u0026thinsp;SLN (%)\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eSLN\u003c/p\u003e\n \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;47)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e62.0 (56.0\u0026ndash;71.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e64.5 (56.0\u0026ndash;74.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.0 (56.0\u0026ndash;70.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.392\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.0 (25.0\u0026ndash;37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e30.0 (25.0\u0026ndash;36.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e30.0 (25.0\u0026ndash;37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,.54\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI\u0026thinsp;\u0026lt;\u0026thinsp;30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e44 (45.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e20 (42.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBMI =/\u0026gt; 30\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e53 (54.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e27 (57.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSurgical approach\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLaparoscopic\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32 (33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e26 (52%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e6 (12.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eRobotics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e65 (67.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e24 (48.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e41 (87.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistological type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEndometrioid\u003c/p\u003e\n \u003cp\u003eSerous\u003c/p\u003e\n \u003cp\u003eClear cell\u003c/p\u003e\n \u003cp\u003eCarcinosarcoma\u003c/p\u003e\n \u003cp\u003eOthers\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e71 (73.2%)\u003c/p\u003e\n \u003cp\u003e13 (13.4%)\u003c/p\u003e\n \u003cp\u003e2 (2.1%)\u003c/p\u003e\n \u003cp\u003e6 (6.2%)\u003c/p\u003e\n \u003cp\u003e5 (5.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e35 (70%)\u003c/p\u003e\n \u003cp\u003e10 (20%)\u003c/p\u003e\n \u003cp\u003e1 (2%)\u003c/p\u003e\n \u003cp\u003e4 (8.0%)\u003c/p\u003e\n \u003cp\u003e0 (0.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e36 (76.6%)\u003c/p\u003e\n \u003cp\u003e3 (6.4%)\u003c/p\u003e\n \u003cp\u003e1 (2.1%)\u003c/p\u003e\n \u003cp\u003e2 (4.3%)\u003c/p\u003e\n \u003cp\u003e5 (10.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eESGO/ESTRO/ESP Risk group\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLow\u003c/p\u003e\n \u003cp\u003eIntermediate\u003c/p\u003e\n \u003cp\u003eHigh-intermediate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (38.1%)\u003c/p\u003e\n \u003cp\u003e29 (29.9%)\u003c/p\u003e\n \u003cp\u003e31 (31.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e16 (32.0%)\u003c/p\u003e\n \u003cp\u003e10 (20%)\u003c/p\u003e\n \u003cp\u003e24 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e21 (44.7%)\u003c/p\u003e\n \u003cp\u003e19 (40.4%)\u003c/p\u003e\n \u003cp\u003e7 (14.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\" colspan=\"1\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAdjuvant Therapy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e37 (38.9%)\u003c/p\u003e\n \u003cp\u003e60 (61.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e14 (28%)\u003c/p\u003e\n \u003cp\u003e36 (72%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e24 (51.1%)\u003c/p\u003e\n \u003cp\u003e23 (48.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ePara-aortic lymphadenectomy\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e57 (58.8%)\u003c/p\u003e\n \u003cp\u003e40 (41.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19 (38%)\u003c/p\u003e\n \u003cp\u003e31 (62%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e38 (80.9%)\u003c/p\u003e\n \u003cp\u003e9 (19.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0,000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003ctfoot\u003e\n \u003ctr\u003e\n \u003ctd colspan=\"7\"\u003eBMI: Body Mass Index; ESGO/ESTRO/ESP: European Society of Gynaecological Oncology/European Society for Radiotherapy and Oncology; European Society of Pathology; CL: Complet Lymphadenectomy; SLN: Sentinel Lymph Node biopsy\u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tfoot\u003e\n \u003c/table\u003e\n \u003c/div\u003e\n\u003c/div\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStudy Population\u003c/h2\u003e \u003cp\u003eA total of 97 patients were included: 50 underwent complete lymphadenectomy (CL group) and 47 underwent sentinel lymph node biopsy alone (SLN group). Baseline characteristics were similar between groups regarding age, body mass index (BMI), histologic type, and ESGO/ESTRO/ESP risk classification [6](Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe surgical approach differed significantly: 87.2% of patients in the SLN group underwent robotic surgery compared to 48% in the CL group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eQuality of Life and Health Perception\u003c/h2\u003e \u003cp\u003eAt six months, patients in the SLN group had significantly better HRQoL scores (median 5 vs. 7; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) and higher overall health perception scores (median 85 vs. 70; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001) compared to the CL group (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e). Additionally, the SLN group showed greater stability in oHP over time, while the CL group experienced a decline (median change: 0 vs. -7.5; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.011).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLymphedema and Lymphocele\u003c/h3\u003e\n\u003cp\u003eSymptomatic lymphedema (LELQ score\u0026thinsp;\u0026ge;\u0026thinsp;5) was reported in 34.4% of patients in the CL group versus 7.0% in the SLN group (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.002) (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Three cases of lymphocele (6%) were identified in the CL group; none occurred in the SLN group. Two of the lymphocele cases required interventional drainage.\u003c/p\u003e \u003cp\u003eMultivariate analysis confirmed a significantly lower risk of lymphedema in the SLN group (OR 0.096, 95% CI 0.020\u0026ndash;0.459; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and lower odds of deteriorated health perception (OR 0.208, 95% CI 0.063\u0026ndash;0.688; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.010).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eSurgical Morbidity\u003c/h3\u003e\n\u003cp\u003eIntraoperative complications occurred only in the CL group (3 cases; 6.0%) and included one bladder injury, one intestinal injury, and one anesthesia-related event. Postoperative complications occurred in 11 patients (11.3%), with no significant difference between groups (12.0% CL vs. 10.6% SLN; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.833) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eFour patients developed obturator nerve neuropathy (two in each group), all attributed to thermal injury. Three resolved with rehabilitation, while one case had persistent mild symptoms at six months.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eImpact of BMI, Para-aortic Lymphadenectomy, and Adjuvant Treatment\u003c/h2\u003e \u003cp\u003eObesity (BMI\u0026thinsp;\u0026ge;\u0026thinsp;30) was not significantly associated with worse HRQoL or oHP outcomes. Para-aortic lymphadenectomy was performed more frequently in the CL group (62% vs. 19.1%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) but was not associated with increased risk of lymphedema or reduced QoL in multivariate models.\u003c/p\u003e \u003cp\u003eAdjuvant therapy was more common in the CL group (73.5% vs. 50%; \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.018). Among patients with symptomatic lymphedema, 80% had received adjuvant therapy, although this was not statistically significant (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.093).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eIntra- and post-operative complications\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eComplications\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCL\u0026thinsp;+\u0026thinsp;SLN, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSLN, n (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003ep\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntraop. Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e3 (3.1%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e3 (6.0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0 (0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.243\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBladder injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIntestinal injury\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnaesthetic complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePost-op. Complications\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e11 (11.3%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e6 (12.0%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e5 (10.6%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.833\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSurgical wound infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOver-infected Lymphocele\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eObturator nerve neuropathy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFever\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eIntraop: intraoperative; Post-op: Postoperative. CL: complete Lymphadenectomy; SLN: Sentinel Lymph node biopsy\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective cohort study demonstrates that sentinel lymph node (SLN) biopsy in early-stage endometrial cancer is associated with improved patient-reported outcomes, including better health-related quality of life (HRQoL), higher overall health perception (oHP), and a lower incidence of symptomatic lower-limb lymphedema, compared to complete pelvic lymphadenectomy (CL). These findings reinforce current clinical guidelines that advocate for SLN biopsy as a less invasive and more patient-centered approach to surgical staging.\u003c/p\u003e\n\u003cp\u003eDespite the growing evidence of SLN mapping in endometrial cancer, many studies have shown a lower incidence of Lymphedema, bit few prospective studies analyze the impact on quality of life (QoL). Geppert et al. reported a lower incidence of leg lymphedema with SLN (1.3%) versus systematic lymphadenectomy (18.1%) (8) but did not assess the impact on QoL. Similarly, our study observed a significantly lower rate of symptomatic lymphedema in the SLN group (7.0%) compared to the CL group (34.4%). Importantly, we also found a favourable impact on overall quality of life and self-perceived health, outcomes that are less frequently evaluated in the literature.\u003c/p\u003e\n\u003cp\u003eWedin et al. (9) found that generic HRQoL was not significantly affected by lymphadenectomy but did report lower limb lymphedema-specific QoL deterioration In contrast, our results show significant differences in both generic and specific patient-reported outcomes. The inclusion of validated instruments such as EQ-5D-3L and LELQ strengthens the reliability of these findings.\u003c/p\u003e\n\u003cp\u003eWhile para-aortic lymphadenectomy and adjuvant therapy were more frequently performed in the CL group, multivariate analyses suggest that the type of nodal staging technique (SLN vs. CL) had the greatest influence on QoL and lymphedema risk. These results emphasize the importance of minimizing surgical morbidity without compromising oncologic safety.\u003c/p\u003e\n\u003cp\u003eOther risk factors, such as obesity and age, can influence QoL scales. The study by Karatasli et al. investigated the impact of BMI on the QoL of patients with endometrial cancer and concluded that the group with morbid obesity had poorer physical functioning than the group without morbid obesity (p \u0026lt; 0.011) (10). \u0026nbsp;In our series, patients with a BMI \u0026gt;30 showed a worsening of HR-QoL (62.9% vs 37.1%; p=0.308) and worse oHP (57.9% vs 42.1%; p=0.872). The majority of lymphedemas (80%) and lymphoceles (66.7%) were diagnosed in patients with a BMI \u0026lt;30, but there were no differences in the LELQ, which reflects lymphedema symptoms.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ePelvic radiation has been suggested as an important risk factor for lymphedema although other authors did not find post-operative radiation to be a predictive factor for lymphedema \u0026nbsp;In our series, after multivariate analysis, 80% (12 patients) of those with an LELQ score \u0026gt;5 (symptomatic lymphedema) had received complementary treatment (brachytherapy/external radiotherapy with or without chemotherapy), while only 20% of patients who had not received complementary treatment scored positive on the LELQ. These differences were not statistically significant (p=0.093), likely due to the small number of cases in both groups.\u003c/p\u003e\n\u003cp\u003eOur study has several strengths. It is one of the few prospective studies comparing SLN biopsy and CL with a focus on quality of life, using validated patient-reported outcomes and balanced group sizes, unlike other studies ((11)(12). Limitations include its single-center design and the absence of specific assessment of sexual function (12) or long-term follow-up beyond six months. Additionally, the impact of confounding comorbidities such as osteoarthritis or cardiovascular disease was not formally evaluated.\u003c/p\u003e\n\u003cp\u003eFrom a clinical perspective, these results support the routine use of SLN biopsy for staging in early-stage endometrial cancer. Beyond its diagnostic value, this technique offers meaningful benefits in survivorship outcomes, particularly in minimizing physical and psychological burdens associated with postoperative complications like lymphedema.\u003c/p\u003e\n\u003cp\u003eIn conclusion, sentinel lymph node biopsy provides a less invasive staging option in early-stage endometrial cancer, offering significant improvements in patient-reported quality of life and a lower risk of symptomatic lymphedema compared to complete lymphadenectomy. These findings support the adoption of SLN biopsy as the standard approach in appropriate patients, contributing not only to accurate staging but also to enhanced long-term well-being and survivorship care.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eA.T. and J.A. conceived and designed the study. A.T., A.S., A.R., and L.F. collected and curated the data. A.T. and A.R. performed the statistical analysis. A.T, J.A., M.R., J.R., and C.S. contributed to patient care and surgical procedures. P.R. and O.C. provided methodological oversight and critical revision of the manuscript. A.T. drafted the manuscript, and all authors reviewed and approved the final version.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eThe datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of interests:\u0026nbsp;\u003c/strong\u003eThe authors declare no relevant financial or non-financial conflicts of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthical approval:\u0026nbsp;\u003c/strong\u003eThe study was approved by the Ethics Committee of the Balearic Islands, Spain (CEI-IB Ref. IB 4103/20 PI) and conducted in accordance with the Declaration of Helsinki.\u003c/p\u003e\n\u003cp\u003eConsent to participate: Informed consent was obtained from all the individual participants included in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e:\u0026nbsp;\u003c/strong\u003eWe would like to thank Aina Millan (IdISBa) for her support with statistical analysis, and all patients who kindly agreed to participate in this study.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCrosbie EJ, Kitson SJ, McAlpine JN, Mukhopadhyay A, Powell ME, Singh N. Endometrial cancer. Lancet. 2022 Apr 9;399(10333):1412\u0026ndash;28.\u003c/li\u003e\n \u003cli\u003eMiller KD, Nogueira L, Devasia T, Mariotto AB, Yabroff KR, Jemal A, et al. Cancer treatment and survivorship statistics, 2022. CA Cancer J Clin. 2022;72(5):409\u0026ndash;36.\u003c/li\u003e\n \u003cli\u003e\u0026ldquo;The Statistical Office of the European Union.\u0026rdquo; Mortality and life expectancy statistics [Internet]. Eurostat. 2017. Available from: http://ec.europa.eu/eurostat/statistics-explained/index.php/Mortality_and_life_expectancy_statistics\u003c/li\u003e\n \u003cli\u003eASTEC study group T writing committee on behalf of the A study, Kitchener H, Swart AMC, Qian Q, Amos C, Parmar MKB. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet (London, England) [Internet]. 2009 Jan 10 [cited 2019 Mar 31];373(9658):125\u0026ndash;36. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19070889\u003c/li\u003e\n \u003cli\u003ePanici PB, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. JNCI J Natl Cancer Inst [Internet]. 2008 Dec 3 [cited 2024 Oct 20];100(23):1707\u0026ndash;16. Available from: https://dx.doi.org/10.1093/jnci/djn397\u003c/li\u003e\n \u003cli\u003eConcin N, Matias-Guiu X, Vergote I, Cibula D, Mirza MR, Marnitz S, et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int J Gynecol Cancer. 2021;31(1):12\u0026ndash;39.\u003c/li\u003e\n \u003cli\u003eHolloway RW, Abu-Rustum NR, Backes FJ, Boggess JF, Gotlieb WH, Jeffrey Lowery W, et al. Sentinel lymph node mapping and staging in endometrial cancer: A Society of Gynecologic Oncology literature review with consensus recommendations. Gynecol Oncol [Internet]. 2017;146(2):405\u0026ndash;15. Available from: http://dx.doi.org/10.1016/j.ygyno.2017.05.027\u003c/li\u003e\n \u003cli\u003eGeppert B, L\u0026ouml;nnerfors C, Bollino M, Persson J. Sentinel lymph node biopsy in endometrial cancer\u0026mdash;Feasibility, safety and lymphatic complications. Gynecol Oncol [Internet]. 2018;148(3):491\u0026ndash;8. Available from: https://doi.org/10.1016/j.ygyno.2017.12.017\u003c/li\u003e\n \u003cli\u003eWedin M, St\u0026aring;lberg K, Marcickiewicz J, Ahlner E, \u0026Aring;kesson, Lindahl G, et al. Impact of lymphadenectomy and lymphoedema on health-related quality of life 1 year after surgery for endometrial cancer. A prospective longitudinal multicentre study. BJOG An Int J Obstet Gynaecol. 2022;129(3):450\u0026ndash;60.\u003c/li\u003e\n \u003cli\u003eKarataşlı V, Can B, \u0026Ccedil;akır İ, Erkılın\u0026ccedil; S, Kuru O, G\u0026ouml;k\u0026ccedil;\u0026uuml; M, et al. Life quality of endometrioid endometrial cancer survivors: a cross-sectional study. J Obstet Gynaecol (Lahore) [Internet]. 2021 [cited 2024 Nov 3];41(4):621\u0026ndash;5. Available from: https://www.tandfonline.com/doi/abs/10.1080/01443615.2020.1787969\u003c/li\u003e\n \u003cli\u003eGoncalves BT, Dos Reis R, Ribeiro R, Moretti-Marques R, Schamme FK, Oliveira GS, et al. Does sentinel node mapping impact morbidity and quality of life in endometrial cancer? Int J Gynecol Cancer. 2023;33(10):1548\u0026ndash;56.\u003c/li\u003e\n \u003cli\u003eGarc\u0026iacute;a-Pineda V, Hern\u0026aacute;ndez A, Garrido-Mallach S, Rodr\u0026iacute;guez-Gonz\u0026aacute;lez E, Alonso-Esp\u0026iacute;as M, Gracia M, et al. Sentinel Lymph Node Impact on the Quality of Life of Patients with Endometrial Cancer. J Pers Med. 2023;13(5).\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"quality of life, endometrial cancer, Lymphedema, Sentinel Lymph node, cancer survivors","lastPublishedDoi":"10.21203/rs.3.rs-6477370/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6477370/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003ePurpose\u003c/strong\u003e\u003cbr\u003e\nThis study aimed to compare health-related quality of life (HRQoL), overall health perception (oHP), and the incidence of lower-limb lymphedema in early-stage endometrial cancer patients undergoing either sentinel lymph node (SLN) biopsy or complete pelvic lymphadenectomy (CL).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003cbr\u003e\nIn this prospective, single-center study, 97 patients diagnosed with early-stage endometrial cancer underwent either SLN biopsy alone (n=47) or SLN mapping followed by CL (n=50). HRQoL and oHP were assessed using the EQ-5D-3L and a 0–100 visual analogue scale at baseline and six months postoperatively. Lymphedema was evaluated using the Self-report Lower-Extremity Lymphedema Questionnaire (LELQ).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003cbr\u003e\nPatients in the SLN group reported significantly higher oHP (median 85 vs. 70; \u003cem\u003ep\u003c/em\u003e=0.001) and better HRQoL scores (median 5 vs. 7; \u003cem\u003ep\u003c/em\u003e=0.001) compared to the CL group. Symptomatic lymphedema was more frequent in the CL group (34.4% vs. 7.0%; \u003cem\u003ep\u003c/em\u003e=0.002). No significant differences were observed in intraoperative or postoperative complications between the groups.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003cbr\u003e\nSLN biopsy was associated with improved patient-reported outcomes and a lower incidence of lymphedema, with similar surgical safety compared to complete lymphadenectomy. These findings support SLN biopsy as a preferred nodal staging technique in early-stage endometrial cancer.\u003c/p\u003e","manuscriptTitle":"Impact of Sentinel Lymph Node Biopsy Versus Complete Lymphadenectomy on Quality of Life and Lymphedema in Early-Stage Endometrial Cancer: A Prospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-05-09 11:02:53","doi":"10.21203/rs.3.rs-6477370/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"f4f6c51e-6ff3-46a5-81ba-d233664bc1c0","owner":[],"postedDate":"May 9th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-06-16T17:08:42+00:00","versionOfRecord":[],"versionCreatedAt":"2025-05-09 11:02:53","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6477370","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6477370","identity":"rs-6477370","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}