Evolution of retroperitoneal staging in endometrial cancer: narrative review and overview of literature

Endometrial cancer (EC) is the most common female genital tract malignant cancer. Lymphatic staging is a major prognostic factor and the main predictor of recurrence. The aim of this review is to explore lymph nodal management in EC up to this day and understand how the new molecular EC classification may affect lymph nodal management. A search was conducted in December 2022 to find all relevant trials and shows how, over the years, staging techniques have evolved, becoming more accurate and less invasive. In 1996, a less invasive staging method was found: the Sentinel Lymph Node (SLN), safer and more reliable in detecting metastatic disease. To date, the available pieces of evidence suggests that lymphadenectomy should not be performed in all patients with EC because it does not increase Overall Survival (OS) or Disease Free Survival (DFS) compared to standard surgery without lymphadenectomy, while it actually increases the risk of postoperative complications, in all EC risk classes. In addition, SLN and lymphadenectomy do not have any difference in terms of Recurrence Free Survival (RFS) in patients with low volume disease. Moreover, data available in literature highlight that the molecular classification may play a more accurate prognostic role than histological analysis. Even though some studies showed that the molecular mutations were not significant predictors of recurrence, several large ongoing trials may set new treatment standards. In conclusion, we can state that SLN mapping is an optimal method of EC staging with good sensibility, specificity and decreased surgical complications. Instead, more studies are needed to understand how molecular mutations can affect lymph nodal management.