Evolving paradigms in lymph node surgery in endometrial cancer: insights from the multicenter E-PEC trial

Abstract Objective To describe temporal trends in lymph node staging for endometrial cancer in selected German academic centers between 2018 and 2022. Methods In this multicenter retrospective cohort study, patients who underwent primary surgical treatment for newly diagnosed endometrial cancer between 2018 and 2022 at six German university hospitals were included. Patients receiving primary systemic or chemoradiation therapy were excluded. Patient characteristics and treatment details were analyzed descriptively and stratified by year of surgery. This multicenter retrospective cohort study was conducted as part of the E-PEC project, an ethics-approved multicenter project assessing surgical management patterns in newly diagnosed endometrial cancer. Results A total of 644 patients met the inclusion criteria. Overall, 62.4% underwent lymph node surgery. Sentinel-based procedures were increasingly performed over time and accounted for 61.4% of all nodal staging procedures. In contrast, the rate of primary systematic lymphadenectomy significantly decreased from 30.3% in 2018 to 17.9% in 2022 ( p < 0.05). Conclusions We observed a temporal increase in less radical lymph node procedures in selected German academic centers during the study period. Sentinel-based techniques were increasingly used over time in parallel with evolving guideline recommendations.