{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T13:12:30Z","timestamp":1775567550352,"version":"3.50.1"},"reference-count":28,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T00:00:00Z","timestamp":1775520000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Current Oncology"],"abstract":"<jats:p>Background: Endometrial cancer is the most common gynecologic malignancy in developed countries. Sentinel lymph node (SLN) mapping has emerged as a less invasive alternative to systematic lymphadenectomy and is increasingly incorporated into surgical staging algorithms. Vaginal natural orifice transluminal endoscopic surgery (vNOTES) provides transvaginal access to the retroperitoneum and may facilitate SLN mapping while potentially reducing postoperative morbidity, including lower extremity lymphedema (LEL). Objective: This study aimed to evaluate the feasibility of vNOTES hysterectomy with bilateral salpingo-oophorectomy (BSO) and retroperitoneal SLN mapping and to report early postoperative lymphedema outcomes in patients with newly diagnosed endometrial cancer. Methods: This retrospective cohort study included 113 patients who underwent vNOTES-assisted hysterectomy with BSO and SLN mapping using methylene blue dye at a tertiary referral center between January 2022 and January 2023. Lymphedema was evaluated using the Gynecologic Cancer Lymphedema Questionnaire at 6 and 12 months postoperatively, supported by clinical examination. Descriptive statistical analyses were performed to summarize clinical characteristics and symptom profiles. Results: The mean patient age was 55.0 \u00b1 10.5 years and the mean BMI was 30.94 \u00b1 2.54 kg\/m2. Endometrioid adenocarcinoma was the most common histological subtype (75.5%), and most tumors were grade 1 (57.1%). SLN mapping was successful in 102 of 113 patients (overall detection rate 90.3%), with bilateral detection in 79.6% and unilateral detection in 10.6% of cases. Limb swelling was reported in 4.1% of patients, while only one patient (1.0%) met the criteria for self-reported mild lymphedema. No clinical signs of inguinal lymphedema were detected. Conclusions: vNOTES hysterectomy combined with retroperitoneal SLN mapping was associated with a low incidence of postoperative lower extremity lymphedema in this single-arm cohort. These findings suggest that vNOTES-assisted SLN mapping may represent a feasible minimally invasive approach for nodal assessment in selected patients with endometrial cancer. Prospective comparative studies are required to confirm these findings and to evaluate long-term oncologic and lymphatic outcomes.<\/jats:p>","DOI":"10.3390\/curroncol33040208","type":"journal-article","created":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:03:47Z","timestamp":1775563427000},"page":"208","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Minimizing Lymphatic Morbidity: Incidence of Lower Extremity Lymphedema After vNOTES-Assisted Sentinel Node Mapping in Endometrial Cancer"],"prefix":"10.3390","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9763-5912","authenticated-orcid":false,"given":"Duygu","family":"Kurtulus","sequence":"first","affiliation":[{"name":"Department of Physical Therapy and Rehabilitation, Faculty of Medicine, Memorial Atasehir Hospital, T.C. \u00dcsk\u00fcdar University, 34662 Istanbul, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-5300-6536","authenticated-orcid":false,"given":"Kevser","family":"Arkan","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21010 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2137-2986","authenticated-orcid":false,"given":"Ali Deniz","family":"Erkmen","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21010 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6520-2357","authenticated-orcid":false,"given":"Gul","family":"Cavusoglu Colak","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21010 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8609-3049","authenticated-orcid":false,"given":"Sedat","family":"Akgol","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Diyarbakir Gazi Yasargil Research and Training Hospital, 21010 Diyarbakir, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3797-8227","authenticated-orcid":false,"given":"Behzat","family":"Can","sequence":"additional","affiliation":[{"name":"Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Bower Hospital, 21100 Diyarbak\u0131r, Turkey"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,7]]},"reference":[{"key":"ref_1","first-page":"17","article-title":"Cancer statistics, 2023","volume":"73","author":"Siegel","year":"2023","journal-title":"CA Cancer J. Clin."},{"key":"ref_2","unstructured":"American Cancer Society (2026, January 15). Key Statistics for Endometrial Cancer. Available online: https:\/\/www.cancer.org\/cancer\/types\/endometrial-cancer\/about\/key-statistics.html."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"423","DOI":"10.14740\/wjon1824","article-title":"A Retrospective Study of Complications Following Pelvic and Para-Aortic Lymphadenectomy in Gynecologic Oncology","volume":"15","author":"Saemathong","year":"2024","journal-title":"World J. Oncol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1707","DOI":"10.1093\/jnci\/djn397","article-title":"Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial","volume":"100","author":"Basile","year":"2008","journal-title":"J. Natl. Cancer Inst."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"469","DOI":"10.1016\/S1470-2045(11)70070-5","article-title":"Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: A prospective multicentre study (SENTI-ENDO)","volume":"12","author":"Ballester","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"384","DOI":"10.1016\/S1470-2045(17)30068-2","article-title":"A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study","volume":"18","author":"Rossi","year":"2017","journal-title":"Lancet Oncol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1111\/1471-0528.15504","article-title":"Hysterectomy by transvaginal natural orifice transluminal endoscopic surgery versus laparoscopy as a day-care procedure: A randomised controlled trial","volume":"126","author":"Baekelandt","year":"2019","journal-title":"BJOG"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"665","DOI":"10.1016\/j.jmig.2022.01.007","article-title":"Is. V-NOTES Hysterectomy as Safe and Feasible as Outpatient Surgery Compared with Vaginal Hysterectomy?","volume":"29","author":"Merlier","year":"2022","journal-title":"J. Minim. Invasive Gynecol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1016\/j.ygyno.2019.11.003","article-title":"Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy","volume":"156","author":"Leitao","year":"2020","journal-title":"Gynecol. Oncol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1016\/j.tjog.2024.04.008","article-title":"Lower limb lymphedema after surgical staging for endometrial cancer: Current insights and future directions","volume":"63","author":"Cucinella","year":"2024","journal-title":"Taiwan J. Obstet. Gynecol."},{"key":"ref_11","first-page":"23","article-title":"Frequency and risk factors of lower limb lymphedema following lymphadenectomy in patients with gynecological malignancies","volume":"34","author":"Graf","year":"2013","journal-title":"Eur. J. Gynaecol. Oncol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"5138","DOI":"10.1002\/cncr.25458","article-title":"Lymphedema beyond breast cancer: A systematic review and meta-analysis of cancer-related secondary lymphedema","volume":"116","author":"Cormier","year":"2010","journal-title":"Cancer"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1334","DOI":"10.1016\/j.ejso.2020.01.033","article-title":"Risk factors for late-onset lower limb lymphedema after gynecological cancer treatment: A multi-institutional retrospective study","volume":"46","author":"Yoshihara","year":"2020","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Zhai, L., Zhang, X., Cui, M., and Wang, J. (2021). Sentinel Lymph Node Mapping in Endometrial Cancer: A Comprehensive Review. Front. Oncol., 11.","DOI":"10.3389\/fonc.2021.701758"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Terada, S., Tanaka, T., Murakami, H., Tsuchihashi, H., Toji, A., Daimon, A., Miyamoto, S., Nishie, R., Ueda, S., and Hashida, S. (2023). Lymphatic Complications Following Sentinel Node Biopsy or Pelvic Lymphadenectomy for Endometrial Cancer. J. Clin. Med., 12.","DOI":"10.3390\/jcm12134540"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"503","DOI":"10.1016\/j.ygyno.2017.01.013","article-title":"Impact of sentinel lymph node mapping on recurrence patterns in endometrial cancer","volume":"144","author":"How","year":"2017","journal-title":"Gynecol. Oncol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1016\/j.asjsur.2019.07.014","article-title":"Transvaginal natural orifice transluminal endoscopic surgery (vNOTES) in gynecologic surgeries: A systematic review","volume":"43","author":"Li","year":"2020","journal-title":"Asian J. Surg."},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Reza Pour, N., Benton-Bryant, C., Baekelandt, J., Elhindi, J., Ekanyake, K., and Kapurubandara, S. (2025). Vaginal Natural Orifice Transluminal Endoscopic Surgery for Gynaecological Oncology Procedures: A Systematic Review. Gynecol. Obstet. Investig., 1\u201310.","DOI":"10.1159\/000548436"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1165","DOI":"10.1016\/S0140-6736(09)62002-X","article-title":"Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): A retrospective cohort analysis","volume":"375","author":"Todo","year":"2010","journal-title":"Lancet"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"ASTEC Study Group, Kitchener, H., Swart, A.M., Qian, Q., Amos, C., and Parmar, M.K. (2009). Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet, 373, 125\u2013136. Erratum in Lancet\u00a02009, 373, 1764.","DOI":"10.1016\/S0140-6736(08)61766-3"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1111\/jog.12344","article-title":"Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: Current evidence","volume":"40","author":"Bogani","year":"2014","journal-title":"J. Obstet. Gynaecol. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"676","DOI":"10.1016\/j.ygyno.2019.03.254","article-title":"Sentinel node mapping vs. lymphadenectomy in endometrial cancer: A systematic review and meta-analysis","volume":"153","author":"Bogani","year":"2019","journal-title":"Gynecol. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1311","DOI":"10.1111\/aogs.14843","article-title":"vNOTES retroperitoneal sentinel lymph node dissection for endometrial cancer staging: First multicenter, prospective case series","volume":"103","author":"Baekelandt","year":"2024","journal-title":"Acta Obstet. Gynecol. Scand."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"123","DOI":"10.30720\/ered.1317682","article-title":"Reliability and Validity of the Turkish Version of the Gynecologic Cancer Lymphedema Questionnaire-7 for Individuals with Gynecologic Cancer","volume":"11","author":"Abakay","year":"2023","journal-title":"Ergoter. Rehabil. Derg."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1188\/03.ONF.417-423","article-title":"The experience of lower limb lymphedema for women after treatment for gynecologic cancer","volume":"30","author":"Ryan","year":"2003","journal-title":"Oncol. Nurs. Forum."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"238","DOI":"10.1007\/s10147-010-0171-5","article-title":"Risk factors for lower-limb lymphedema after surgery for cervical cancer","volume":"16","author":"Ohba","year":"2011","journal-title":"Int. J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Tada, H., Teramukai, S., Fukushima, M., and Sasaki, H. (2009). Risk factors for lower limb lymphedema after lymph node dissection in patients with ovarian and uterine carcinoma. BMC Cancer, 9.","DOI":"10.1186\/1471-2407-9-47"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"306.e1","DOI":"10.1016\/j.ajog.2024.09.001","article-title":"Patient-reported lymphedema after sentinel lymph node mapping in women with low-grade endometrial cancer","volume":"232","author":"Groenvold","year":"2025","journal-title":"Am. J. Obstet. Gynecol."}],"container-title":["Current Oncology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/4\/208\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,7]],"date-time":"2026-04-07T12:40:46Z","timestamp":1775565646000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1718-7729\/33\/4\/208"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,7]]},"references-count":28,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["curroncol33040208"],"URL":"https:\/\/doi.org\/10.3390\/curroncol33040208","relation":{},"ISSN":["1718-7729"],"issn-type":[{"value":"1718-7729","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,7]]}}}