Sentinel Lymph Node Mapping in Endometrial Cancer: Experience from a Tertiary Referral Center in Türkiye

Background: Sentinel lymph node (SLN) mapping has become an established alternative to systematic lymphadenectomy for surgical staging in endometrial cancer. This study evaluated SLN mapping rates, anatomical distribution, factors associated with mapping failure, and perioperative outcomes in patients with early-stage endometrial cancer. Methods: This retrospective cohort study included patients with early-stage endometrial cancer who underwent SLN mapping during minimally invasive surgical staging between September 2022 and January 2025. Overall and bilateral SLN detection rates were calculated. Anatomical distribution of SLNs, factors associated with mapping failure (including a hemipelvis-level generalized estimating equation [GEE] analysis), and perioperative outcomes according to surgical approach were analyzed. Results: A total of 165 patients were included. The overall SLN detection rate was 96.4%, and bilateral mapping was achieved in 125 patients (75.8%). A total of 584 SLNs were removed, most commonly from the iliac basin. In the hemipelvis-level GEE analysis (330 hemipelves, 46 failures), ICG use (adjusted odds ratio [OR] 4.50, 95% confidence interval [CI] 1.07–18.83) and, in a sensitivity model, conventional laparoscopy compared with robotic surgery (OR 2.31, 95% CI 1.14–4.69) were associated with higher odds of mapping failure, whereas age and BMI were not. Operative time and intraoperative complication rates were comparable among laparoscopic, robotic-assisted, and vaginal natural orifice transluminal endoscopic surgery (vNOTES) procedures. Postoperative complication rates and length of hospital stay differed significantly across surgical approaches (both p = 0.002); post hoc pairwise comparison of complication rates showed that the difference was driven mainly by conventional laparoscopy compared with robotic-assisted surgery, whereas the small vNOTES group (n = 8) did not differ significantly from either approach and does not permit conclusions on its comparative safety. Conclusions: SLN mapping demonstrated high overall detection rates and acceptable bilateral mapping success in early-stage endometrial cancer. These findings support the feasibility of SLN mapping as a minimally invasive staging strategy in routine clinical practice.