To study the incidence of lymphedema in patients undergoing surgery for endometrial cancer and to see whether sentinel node mapping and biopsy results in reduced rates of lymphedema compared to PLND.

A retrospective single institution analysis including all patients who underwent surgery with nodal assessment for proven or suspected endometrial cancer between January 2010 and July 2021. Patients without 1-year postoperative follow-up were excluded from analysis. Data were obtained from electronic medical records. Each hemipelvis was considered a unit of study. SPSS v.20 was used for statistical analysis.

Of the 816 hemipelvises in 408 patients, 486 underwent SLNB and 330 PLND.

Mean age of SLNB group was younger (57 y and 59.8 y, P < 0.001). Both the groups had similar confounding comorbidities. A mean of 2 (0–8) nodes were obtained in SLNB group and 7 (range 1–26) in PLND group. Average duration of surgery was 123.3 and 197.4min (p < 0.001), and blood loss was 41 and 221.8 ml (p < 0.001) with SLNB and PLND, respectively.

Side-specific lymphedema occurred in 6.37% with PLND and 1.23% with SLNB (p < 0.001). Additionally, 1.7% patients in the PLND group and none in SLNB group reported heaviness of the lower limb without clinically obvious edema (p = 0.005). Two patients with edema after SLNB had varicose veins ipsilaterally. Pelvic Lymphocele was seen in 2.33% patients after PLND and 0.19% after SLNB (p = 0.010).

The present study shows that SLNB is associated with substantially reduced incidence of lymphedema with significantly lower operative time and blood loss.