Home›OB/GYN & Women's Health› Obesity, high-grade tumors, and nonendometrioid histology raise SLN mapping failure risk in endometrial cancer
Obesity, high-grade tumors, and nonendometrioid histology raise SLN mapping failure risk in endometrial cancerObesity and Tumor Grade Linked to Mapping Failures in Cancer Surgery
Journal of minimally invasive gynecologyPublished September 2, 2026Study authors: Qin Zhaojuan, Du Yi, Wan Qi, Zheng AiPubMed ↗DOI ↗Editorial oversight: Dr. Sofia Müller, MD · Lifespan & Whole-Person Care
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Key Takeaway
Consider obesity, high-grade tumors, nonendometrioid histology, and nodal involvement as risk factors for SLN mapping failure.
This is a meta-analysis of observational studies examining factors associated with bilateral sentinel lymph node (SLN) mapping failure in patients with apparent early-stage endometrial cancer undergoing minimally invasive surgery with cervical indocyanine green (ICG)-based SLN mapping. The analysis included 6977 patients. The primary outcome was bilateral SLN mapping failure.
The authors found that obesity (BMI ≥30 kg/m²), high tumor grade (G3), nonendometrioid histology, and lymph node involvement were each significantly associated with an increased risk of bilateral SLN mapping failure. In contrast, age, prior pelvic surgery, tumor size, cervical involvement, FIGO stage, lymphovascular space invasion, and surgical approach were not significantly associated with mapping outcomes.
The meta-analysis did not report effect sizes, confidence intervals, or p-values for these associations. Limitations were not reported. Because this is a meta-analysis of observational studies, the results indicate association, not causation.
The findings suggest that identifying high-risk patients may facilitate individualized surgical planning and intraoperative decision-making. However, clinicians should interpret these associations cautiously, as unmeasured confounders may influence the results.
How this fits prior evidence
This meta-analysis extends prior coverage on endometrial cancer surgical approaches by identifying patient and tumor characteristics that may influence the success of a specific minimally invasive technique, ICG-based SLN mapping. While prior items focused on surgical modality comparisons (e.g., reduced-port robotic surgery, robotic vs. laparoscopic hysterectomy) and systemic therapy (dostarlimab plus niraparib), this finding addresses a gap by highlighting factors that could affect the feasibility of SLN mapping, a key component of surgical staging. The associations with obesity and high-grade tumors align with known challenges in this population, but the lack of effect sizes and causality limits direct comparison.
This meta-analysis looked at data from 6,977 patients with early-stage endometrial cancer. The study focused on the success of using indocyanine green (ICG) to map sentinel lymph nodes during minimally invasive surgery. This mapping process helps surgeons identify where cancer might have spread.
The researchers found that several specific factors were linked to a higher risk of mapping failure. These factors included a high body mass index (BMI of 30 or more), high tumor grade (G3), and nonendometrioid histology. Additionally, the presence of lymph node involvement was associated with more frequent mapping failures.
Other factors, such as the patient's age, the size of the tumor, and the specific surgical approach, did not show a significant link to mapping success. Because this is a meta-analysis of observational studies, these results show a link rather than a direct cause. These findings may help doctors better plan for individual patients during surgery.
What this means for you:
Obesity and high tumor grade are linked to higher rates of mapping failure in endometrial cancer surgery.
Common questions
What factors increase the risk of mapping failure in surgery?
The study found that obesity (a BMI of 30 or more), high tumor grade (G3), and nonendometrioid histology were all significantly associated with an increased risk of bilateral sentinel lymph node mapping failure. Lymph node involvement was also linked to a higher risk of failure during the procedure.
What factors did not affect the success of the mapping?
Several factors did not show a significant association with mapping outcomes. These included the patient's age, the size of the tumor, prior pelvic surgery, cervical involvement, FIGO stage, lymphovascular space invasion, and the specific surgical approach used during the procedure.
How does this information help doctors and patients?
Identifying high-risk patients can help surgical teams plan more effectively. By knowing which factors are linked to mapping failures, doctors may be able to make better decisions during surgery to improve outcomes for patients with early-stage endometrial cancer.
OBJECTIVE: To identify clinicopathological and procedural predictors of bilateral sentinel lymph node (SLN) mapping failure in patients with apparent early-stage endometrial cancer predominantly undergoing minimally invasive surgery with indocyanine green (ICG) fluorescence imaging.
DATA SOURCES: A systematic literature search was performed in PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials from database inception to March 2026. Reference lists of relevant studies were also manually screened.
METHODS OF STUDY SELECTION: Observational studies were included, as randomized trials in this field typically do not report sufficient data on predictors of SLN mapping failure. Eligible studies predominantly involved patients with apparent early-stage disease undergoing minimally invasive surgery with cervical ICG-based SLN mapping and reporting extractable effect estimates or sufficient data for analysis. Studies were excluded if they had overlapping cohorts, used exclusively noncervical injection techniques, or included fewer than 50 patients. Two reviewers independently screened studies and extracted data.
TABULATION, INTEGRATION, AND RESULTS: Sixteen studies comprising 6977 patients were included. Random-effects meta-analysis demonstrated that obesity (BMI ≥30 kg/m²), high tumor grade (G3), nonendometrioid histology, and lymph node involvement were significantly associated with an increased risk of bilateral SLN mapping failure. In contrast, age, prior pelvic surgery, tumor size, cervical involvement, FIGO stage, lymphovascular space invasion, and surgical approach were not significantly associated with mapping outcomes. Heterogeneity was assessed using the I² statistic, and sensitivity analyses confirmed the robustness of the findings.
CONCLUSION: Bilateral SLN mapping failure in endometrial cancer is primarily driven by patient- and tumor-related factors, whereas surgical approach was not significantly associated with mapping outcomes. Identification of high-risk patients may facilitate individualized surgical planning and intraoperative decision-making.
