Pelvic lymphadenectomy is related to a heightened risk of lower-appendage lymphedema. In this proof-of-concept study, the researchers assessed the viability of distinguishing the lower-limb drainage nodes (LLDNs) during pelvic lymphadenectomy for endometrial cancer. Mapping lower-limb drainage and evaluating the predictive value of their mapping technique were their auxiliary goals.

Patients with endometrial cancer who required pelvic lymphadenectomy, without neoadjuvant chemotherapy or radiotherapy, and without a history of lower-limb surgery were included in this prospective cohort study. On the day prior to surgery, a radiopharmaceutical was injected into both feet of the patients. Preoperative lymphoscintigraphy and intraoperative isotopic probe detection were utilized to distinguish LLDNs and were removed before complete pelvic lymphadenectomy. Separate histological analyses were done for the specimens of the LLDNs and the pelvic lymphadenectomy.

About 10 out of 12 patients with early-stage endometrial cancer went through preoperative lymphoscintigraphy, which unswervingly recognized femoral, inguinal, and pelvic LLDNs (rate of detection: 100%). The intraoperative discovery rate was 83% (10/12).  On the right, the median number of hot nodes per patient was 5 nodes (range: 3–7). On the left, the median number of hot nodes per patient was 3 nodes (range: 2–6).  106 out of 107 LLDNs were in the external iliac area; this included 45 in the medial and intermediate groups and 38 in the lateral group. None of the patients had node metastases at any site. No early hitches related to the method ensued.

The mapping method seems safe, plausible, and related with a high LLDN distinguishing rate. The risk of lower-limb lymphedema can be decreased and quality of life improved as LLDN mapping may allow LLDNs to be preserved.