Impact of Obesity on Sentinel Lymph Node Mapping in Patients with Endometrial Intraepithelial Neoplasia Undergoing Robotic Surgery: A Retrospective Cohort Study

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Background/Objectives: Lymph node (LN) assessment for cases of endometrial intraepithelial neoplasia (EIN), a known precursor to endometrial cancer (EC), is a topic of debate. Some experts believe this practice could avoid re-staging of disease and influence the decision to administer adjuvant treatment. However, it is known that obtaining sentinel lymph node (SLN) biopsies in patients with an elevated body mass index (BMI) can be more challenging. We thus sought to evaluate the effect of BMI on the SLN detection rate (DR) during robotic hysterectomy in EIN cases. Methods: We conducted a retrospective chart review for patients with a pre-operative diagnosis of EIN who underwent robotic hysterectomy with SLN sampling. Five BMI categories were determined according to the literature. Distribution normality was assessed with the Kolmogorov–Smirnov test. Continuous variables, non-parametric continuous variables and categorical variables were assessed with the appropriate statistical tests (two-tailed Student’s t-tests, Mann–Whitney U-tests, and chi-squared tests, respectively). Results: 115 patients were included (average BMI of 34.75 ± 9.38 SD). The bilateral SLN DR was not significantly different between BMI groups (p = 0.606). The difference in unilateral SLN DR between BMI groups was also non-significant (p = 0.269). When examining high BMI subgroups (BMI > 30 and BMI > 40), no significant difference was found in bilateral nor unilateral SLN DR. A logistic regression model showed that for every unit of BMI, the likelihood of SLN DR did not change significantly. Conclusions: We found no connection between obesity (BMI > 30) or morbid obesity (BMI > 40) and reduced SLN DR in EIN cases, nor a significant variation in the DR when comparing all the different BMI subgroups.

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