Incidence and clinical course of lymphoceles following pelvic sentinel lymph node removal in endometrial cancer

Background: To assess the incidence and clinical course of pelvic lymphoceles following removal of sentinel lymph nodes (SLN) in endometrial cancer (EC). Methods: Between October 2014 and September 2021 consecutive women with a uterine confined EC deemed suitable for robotic surgery and detection of pelvic SLNs at a tertiary academic centre were screened for inclusion. A previously described SLN algorithm with detection of SLNs along parallel pelvic pathways, was adhered to. Follow-up, including a vaginal ultrasonography to detect pelvic lymphoceles, was scheduled every six months until two years post-surgery. The incidence, clinical course of pelvic lymphoceles, and any necessary intervention up to 12 and 24 months, were investigated. Results: A total of 449 women were included. After exclusions of women lost to, or having a remote hospital follow-up, 361 (at 12 months) and 276 (at 24 months) women were included. In ten women, a pelvic lymphocele was identified during the study period where a surgical fenestration was necessary in one patient, and one was treated with antibiotics. The remainder had either asymptomatic or spontaneously resolving lymphoceles. The development of a lymphocele was positively associated with increased Body Mass Index (BMI) (p = 0.005). However, neither adjuvant treatment, age, or the quantity of sentinel lymph nodes (SLNs) removed demonstrated a significant association (p = 0.756, p = 0.971 and p = 0.463 respectively). Conclusions: The overall risk of pelvic lymphocele development post SLN biopsy in women with EC was 2.7%. Eighty percent were either asymptomatic or had a spontaneously resolving lymphocele and the overall risk for intervention was 0.5%. Lymphocele development was associated with BMI but neither with the number of removed SLNs, age or adjuvant treatment. These results support the detection of SLNs in EC regardless of preoperative risk group. Clinical Trial Registration: NCT03680833, retrospectively registered.

Lymphocele; Sentinel lymph node; Endometrial cancer

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