Vaginal natural orifice transluminal endoscopic surgery versus conventional laparoscopy for sentinel lymph node mapping in early-stage endometrial cancer: a systematic review and meta-analysis.
Ozan Karadeniz, Gizem Nur Koyan Karadeniz, Mahjouba Soltani et al.
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In 30 seconds
This systematic review and random-effects meta-analysis compared vaginal natural orifice transluminal endoscopic surgery (vNOTES) with conventional laparoscopy for sentinel lymph node mapping in early-stage endometrial cancer. Four comparative cohort studies included 349 patients. Bilateral detection was 86.8% with vNOTES versus 88.3% with laparoscopy (odds ratio 0.87, 95% confidence interval 0.43 to 1.77, p = .71, I 2 = 0%). Unilateral detection, mapping failure, and most perioperative outcomes were also comparable; hospital stay was shorter after vNOTES.
Key findings
- Bilateral sentinel node detection was 86.8% with vNOTES versus 88.3% with laparoscopy (odds ratio 0.87, 95% confidence interval 0.43 to 1.77, p = .71, I 2 = 0%).
- Unilateral detection and mapping failure rates were comparable between approaches.
- Operative time, estimated blood loss, post-operative pain scores, and complication rates did not differ significantly; hospital stay was shorter after vNOTES.
- The vNOTES conversion rate was 2.7%.
Why it matters
Sentinel node mapping is part of surgical staging for early-stage endometrial cancer, and these findings suggest vNOTES may achieve detection rates and perioperative safety comparable to laparoscopy in selected patients. The shorter hospital stay is a potentially relevant outcome, but the evidence does not establish superiority or support broad adoption.
What to keep in mind
Evidence came from four small, non-randomized cohort studies with substantial risk of bias. Body mass index differed between groups in two studies, and the authors call for prospective randomized trials.