Robotic surgery and sentinel lymph node biopsy improve perioperative outcomes in endometrial cancer treatment

Dec. 21, 2019

Mayo Clinic in Rochester, Minnesota, is a major referral center for endometrial cancer; it is known worldwide for its innovative treatment and research of this disease. Throughout the last decade, the paradigm of endometrial cancer surgery has shifted away from open surgery to a minimally invasive approach ― an approach that includes alterations that allow patients to recover more quickly with fewer complications.

"In 2008, 20% of patients with endometrial cancer treated at Mayo Clinic received minimally invasive surgery. Today more than 95% of patients with endometrial cancer receive minimally invasive, rather than open, surgery," says Andrea Mariani, M.D., M.S., with Gynecologic Surgery at Mayo Clinic in Rochester, Minnesota. "This change has been facilitated by the advent of robotic surgery, which allows safe reproducibility of minimally invasive surgery, even in patients who are morbidly obese. The shift toward robotic surgery has resulted in significantly less morbidity and a shorter hospital stay for patients with endometrial cancer."

As reported in a study published in Gynecologic Oncology in 2016, Dr. Mariani and a research team at Mayo Clinic explored the effects of robot-assisted surgery on treatment-related morbidity and cost of endometrial cancer staging. The team evaluated morbidity and costs among 251 patients with endometrial cancer who received robot-assisted surgery and 384 patients who had open staging.

"Patients who experienced robot-assisted surgery had significantly fewer postoperative complications, lower perioperative transfusion rates, lower readmission rates and shorter hospital stays," says Dr. Mariani. "The advent of minimally invasive surgery has also helped facilitate hospital patient flow and increased patient access to the hospital gynecologic unit."

Sentinel node technique improves outcomes

More recently, the gynecologic oncology team has introduced the sentinel lymph node technique at Mayo Clinic. The main route of metastasis in endometrial cancer is through the lymph nodes. Traditionally, lymph node metastases have been detected by performing systematic pelvic and para-aortic lymphadenectomy.

During the last five years, however, Mayo care teams have gradually shifted their approach to precision surgery with identification of sentinel lymph nodes. "Intensive surgical staging with removal of many lymph nodes has evolved toward an intensive pathologic staging, with a very comprehensive analysis of just a few important lymph nodes," says Dr. Mariani. "A dye is injected into the uterine cervix. Then, infrared technology allows visualization of the first few draining lymph nodes, which are then biopsied, thus reducing the need for full lymphadenectomy."

Dr. Mariani and fellow researchers published a study in the International Journal of Gynecological Cancer in 2019 that demonstrates that the sentinel node technique has improved the already excellent outcomes of robotic surgical staging in endometrial cancer.

In comparing sentinel lymph node biopsy to traditional surgical staging, Dr. Mariani says, "We found that surgery has become faster with even less perioperative morbidity, and we observed that the sentinel lymph node technique does not significantly increase the morbidity of hysterectomy alone."

For more information

Bogani G, et al. Incorporating robotic-assisted surgery for endometrial cancer staging: Analysis of morbidity and costs. Gynecologic Oncology. 2016;141:218.

Casarin J, et al. Sentinel lymph node biopsy for robotic-assisted endometrial cancer staging: further improvement of perioperative outcomes. International Journal of Gynecological Cancer. In press.