Nodal staging in endometrial cancer: quality of life, patient-reported outcomes, and survivorship.

OBJECTIVES

To evaluate quality of life, patient-reported outcomes, and survivorship after different nodal staging strategies in endometrial cancer, with a focus on lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy.

METHODS

A systematic literature search was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. MEDLINE (through PubMed), Embase, and Scopus were searched for studies published from 2010 to 2025. Eligible studies included women with endometrial cancer who underwent surgical nodal staging with sentinel lymph node mapping, lymphadenectomy, or combined approaches and reported validated quality-of-life or patient-reported outcomes.

RESULTS

Nine comparative studies including 3298 patients treated between 2006 and 2023 were included. Sentinel lymph node mapping alone was performed in 1334 women, 1508 underwent lymphadenectomy with or without sentinel lymph node mapping, and 456 underwent hysterectomy alone. Patient-reported lower-extremity lymphedema was consistently less frequent after sentinel lymph node mapping than after lymphadenectomy. Reported lymphedema prevalence ranged from 2% to 36% after sentinel lymph node mapping versus 21% to 51% after lymphadenectomy. Studies using multi-variable analyses consistently identified more extensive nodal dissection as an independent predictor of increased lymphatic morbidity. Global quality-of-life scores showed no consistent differences between nodal staging strategies; however, symptom-specific and functional outcomes, particularly lower-extremity symptoms and physical functioning, more often favored sentinel lymph node mapping. Considerable heterogeneity was observed in surgical approach, outcome measures, and timing of assessment.

CONCLUSION

Although differences in global quality of life remain inconsistent, sentinel lymph node mapping appears to reduce patient-reported lymphatic morbidity compared with more extensive nodal dissection. These findings support the integration of patient-reported outcomes into nodal staging decision-making and reinforce the survivorship advantages of less extensive surgical staging strategies in endometrial cancer.