Abstract
BACKGROUND: Systematic pelvic lymph node dissection (PLND) is the conventional staging procedure for early-stage endometrial cancer but is associated with substantial morbidity, particularly lower-limb lymphedema. Sentinel lymph node biopsy (SLNB) is a less invasive alternative, yet real-world evidence on complications and patient-reported quality of life (QoL) remains limited. OBJECTIVE: To compare perioperative outcomes, postoperative complications, and QoL between SLNB and PLND in low- to intermediate-risk endometrial cancer, and to determine whether surgical approach is an independent risk factor for complications. METHODS: We retrospectively analyzed 150 eligible patients with early-stage endometrial cancer treated at a gynecologic oncology center between January 2020 and December 2023, with ≥12 months of follow-up. Based on contemporaneously documented clinical decision-making and patient preference, patients were assigned to the SLNB group (n = 100) or the PLND group (n = 50). SLNB was performed using cervical indocyanine green injection with near-infrared fluorescence imaging; PLND comprised systematic pelvic lymphadenectomy. Outcomes included operative time, estimated blood loss, length of hospital stay, overall complications graded by Clavien-Dindo, 12-month lymphedema incidence, SLN mapping success rate, lymph node pathology (including ultrastaging), and QoL assessed by the EORTC QLQ-C30 preoperatively and at 3, 6, and 12 months. Univariate and multivariate logistic regression analyses were conducted to identify independent risk factors for postoperative complications. RESULTS: Baseline characteristics (age, BMI, FIGO stage) were comparable between groups (all p > 0.05). Compared with PLND, SLNB was associated with shorter operative time (p < 0.001), lower blood loss (p < 0.001), and shorter postoperative hospital stay (p = 0.001). The patient-level SLN mapping success rate was 97.0%. Overall complication rates (p < 0.001) and 12-month lymphedema incidence (p < 0.001) were significantly lower in the SLNB group. Ultrastaging detected six additional cases of micrometastases or isolated tumor cells in the SLNB group (p = 0.016). Global health status scores were higher after SLNB at 3 months (p = 0.007) and 6 months (p = 0.041). In multivariate analysis adjusting for age, BMI, diabetes, and FIGO stage, PLND remained an independent risk factor for postoperative complications (aOR 4.732; 95% CI 2.029-11.034; p < 0.001). CONCLUSION: In low- to intermediate-risk early-stage endometrial cancer, SLNB provides effective staging with reduced surgical burden, fewer postoperative complications-particularly lymphedema-and earlier recovery of QoL compared with systematic PLND.