Assessing the role of low volume disease in endometrial cancer

The role of retroperitoneal staging in endometrial cancer is still unclear. Although the prognostic value of lymphadenectomy has been demonstrated no data support the therapeutic value of nodal dissection. Sentinel node mapping represents an evolution of lymphadenectomy. Sentinel node mapping allows a more accurate identification of low-volume diseases (i.e., micrometastasis and isolated tumor cells) that are not always detectable via conventional histopathological evaluation. Adjuvant therapy might play a role in patients with low-volume disease. However, the presence of isolated tumor cells alone seems to not impact outcomes of endometrioid endometrial cancer patients. Hence, the choice to deliver adjuvant therapies has to be tailored based on uterine factors only. The introduction of molecular and genomic profiling would be useful in selecting appropriate surgical and adjuvant treatments. The molecular-integrated risk profile should be integrated in clinical practice to overcome the need of retroperitoneal staging (in case of non-bulky nodes) in patients at low risk.

Automated summary

The role of retroperitoneal staging in endometrial cancer is still unclear. Although lymphadenectomy has prognostic value, there is no therapeutic value of nodal dissection. Sentinel node mapping allows for more accurate detection of low-volume diseases, and adjuvant therapy may be effective for these cases. However, the presence of isolated tumor cells alone does not impact outcomes. Molecular and genomic profiling should be used to guide surgical and adjuvant treatments, reducing the need for retroperitoneal staging.