Endometrial cancer (EC) is the most common gynecologic cancer in developed countries[1]. Most cases are diagnosed in early stages (75%), with a 5-year overall survival (OS) of 74-91%[2]. The standard surgical treatment for patients with EC apparently limited to the uterus includes total simple hysterectomy, bilateral salpingo-oophorectomy and lymph node assessment, except in low-risk cases (FIGO stage IA, grade 1/2)[3,4]. Lymph node involvement in EC is the most important factor for prognosis and tailoring adjuvant treatment. The overall risk of lymph node involvement is relatively low, ranging from 0.8-3.9% for low-risk tumors to around 15.4% for high- and intermediate-risk tumors[5] as defined by European Society for Medical Oncology - European Society of Gynaecological Oncology - European SocieTy for Radiology and Oncology (ESMO-ESGO-ESTRO) risk criteria[6].

SLN biopsy can be considered for staging in low-to-intermediate risk patients and an acceptable alternative to systematic lymphadenectomy in patients with intermediate-to-high or high risk stage I/II EC[2,7], with a higher rate of detection of nodal disease and less morbidity[8]. Treatment protocols for EC including SLN biopsy have been well defined by the scientific societies[9].

These protocols do not include the assessment of para-aortic nodal status[10]. Authors who omit aortic nodal assessment claim that isolated aortic metastasis is very unlikely and therefore the risk of missing disease is negligible[11,12]. But this assertion is controversial, especially in high-risk tumors, and the decision on whether to perform aortic lymphadenectomy for nodal evaluation is generally left to the discretion of the surgeon.

The aims of this study were to assess the feasibility of aortic SLN detection, pelvic and para-aortic SLN detection rate (DR), and location of pelvic and aortic SLNs and to describe overall survival, with dual tracer injection. We also aimed to determine the rates of isolated aortic SLN detection and isolated aortic metastasis in operable EC.