Page 159 - EJMO-9-3

Eurasian Journal of
Medicine and Oncology Pfannenstiel incision in endometrial cancer

lymphadenectomy have been employed for this purpose. was found between the two groups. In our study, port
However, this approach is associated with considerable site metastasis was detected in only one patient after
morbidity, including prolonged operative time, increased laparoscopic surgery. These metastases are rare, with an
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blood loss, lymphocele formation, and lower extremity estimated incidence of <1% in cases of early-stage EC.
lymphedema. In recent years, SLN biopsy has emerged as While no vaginal cuff recurrence was observed in patients
a less invasive alternative that offers accurate staging with who underwent surgery with a Pfannenstiel incision, it was
reduced surgical risk. Several studies have demonstrated observed in a patient who underwent laparoscopic surgery.
that SLN mapping in EC provides high sensitivity and This may be attributable to the use of a uterine manipulator
negative predictive value for the detection of nodal in laparoscopic procedures. Similar concerns were raised
metastasis. Cervical injection of indocyanine green in the phase III LACC trial, where minimally invasive
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followed by near-infrared fluorescence imaging has become radical hysterectomy in cervical cancer was associated with
the preferred technique due to its superior detection significantly lower OS and DFS compared to open abdominal
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capabilities and safety profile. One of the key advantages of surgery. In our study, while no significant difference in OS
the SLN approach is the opportunity for ultrastaging, which was detected between the two groups, DFS was significantly
enhances the detection of micrometastases and isolated better in patients treated with Pfannenstiel incision.
tumor cells that might be missed by routine pathological The OS rate for patients with EC is reported at
evaluation. This is particularly important in patients with approximately 85%. The 5-year DFS and OS rates have
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clinically early-stage disease, where even low-volume nodal been reported as 95.2% and 96.4%, respectively. For
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metastasis may alter the risk stratification and subsequent stage I and stage II tumors, the 5-year survival rate is
treatment plan. Moreover, in patients with negative SLNs, between 74% and 91%. Stuart et al. suggest that pelvic
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systematic lymphadenectomy can often be safely omitted, lymphadenectomy improves overall or recurrence-free
thereby minimizing surgical complications without survival in women with early EC. Furthermore, Alouini
compromising oncologic outcomes. Despite its advantages, and Bakri showed in their review that systematic para-
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SLN mapping is not without limitations. Its success is highly aortic lymphadenectomy may not be necessary in early-
dependent on surgeon expertise, institutional experience, stage genital malignancies. In our study, we found that
and patient factors such as obesity or prior pelvic surgeries, performing only pelvic lymph node sampling—without
which can interfere with lymphatic drainage and reduce para-aortic lymphadenectomy—yielded the OS and DFS
mapping efficacy. In addition, the reliability of SLN biopsy consistent with the literature.
in high-risk histologic subtypes (e.g., serous or clear cell Recent studies also suggest that systemic inflammatory
carcinoma) or in cases with grossly enlarged lymph nodes markers may serve as useful diagnostic and prognostic
remains controversial. Some guidelines still recommend biomarkers. For example, Ronsini et al. demonstrated
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comprehensive lymphadenectomy in these populations how endometrial thickness, when combined with systemic
due to a higher prevalence of nodal metastasis. inflammatory response (SIR) indices, may help distinguish
SLN biopsy represents a significant advancement in between endometrial dysplasia and carcinoma in patients
the surgical management of EC. It offers an accurate, with postmenopausal bleeding. However, our study did
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minimally invasive alternative to full lymphadenectomy, not incorporate SIR data, which represents a limitation.
particularly in patients with low to intermediate risk There is also a biological perspective on how systemic
disease. When performed in accordance with validated or metabolic factors may influence cancer progression and
protocols and applied to appropriately selected patients, surgical outcomes. A recent systematic review highlights
it provides accurate staging and minimizes surgical the role of trace elements such as selenium, zinc, copper,
morbidity. However, the availability of technology and and cadmium in the pathogenesis and progression of
expertise remains a barrier in some institutions. In our various malignancies. The review suggests that imbalances
center, due to the lack of equipment for SLN sampling, in essential and toxic elements may contribute to oxidative
we performed selective lymph node removal of bulky stress, inflammation, and altered immune responses,
nodes during surgery to achieve surgical staging while potentially affecting both tumor biology and post-operative
minimizing the risk of lymphedema. In our study, we recovery. Unfortunately, our study did not evaluate these
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did not observe any significant difference in the number parameters, which may also be considered a limitation.
of resected lymph nodes between patients undergoing This study has several additional limitations. First,
surgery via Pfannenstiel incision versus laparoscopy.
due to its retrospective design, the selection of surgical
Although the number of patients with recurrence was approach was based on clinical judgment and individual
higher in the laparoscopy group, no significant difference patient characteristics rather than a standardized

Volume 9 Issue 3 (2025) 151 doi: 10.36922/EJMO025150106