Sentinel lymph node biopsy versus lymphadenectomy in early-stage cervical cancer: a meta-analysis of oncologic outcomes and surgical morbidity.

Objective: This study aimed to evaluate the oncologic safety of sentinel lymph node biopsy (SLNB) compared with systematic lymph node dissection (LND) in patients with early-stage cervical cancer and to determine whether SLNB alone yields comparable survival outcomes. Data sources: Studies published up to October 2025 were systematically searched in PubMed, Embase, and Web of Science using relevant keywords, including "sentinel lymph node", "cervical cancer", "cervical carcinoma" and "lymphadenectomy." Study eligibility criteria: Comparative cohort studies and single-arm studies involving patients with early-stage cervical cancer undergoing SLNB, with or without LND, and reporting survival outcomes- including cancer-specific survival (CSS), disease-specific survival (DSS), overall survival (OS), progression-free survival (PFS), and disease-free survival (DFS) -were included. Study appraisal and synthesis methods: The quality of the included studies was assessed using appropriate tools: the Cochrane Risk of Bias 2.0 (RoB 2) tool for randomized controlled trials, the Newcastle-Ottawa Scale (NOS) for observational studies, and the Methodological Index for Non-Randomized Studies (MINORS) for single-arm or non-randomized studies. All meta-analyses were performed using the meta package in R. Hazard ratios (HRs) and risk ratios (RRs) with 95% confidence intervals (CIs) were pooled using fixed- or random-effects models depending on heterogeneity. Sensitivity analyses were conducted via leave-one-out analysis. Results: The pooled analysis of six comparative studies revealed no significant difference in cancer-specific survival (HR = 0.93, 95% CI: 0.27-3.20), overall survival (HR = 0.92 (95% CI: 0.65-1.31), disease-free survival (HR = 0.99, 95%CI: 0.00-855.48), or progression-free survival (HR = 0.71, 95% CI: 0.29-1.05) between the SLNB and LND groups. SLNB was associated with a significantly lower risk of postoperative complications (RR = 0.70, P = 0.0406), and did not increase the recurrence rate (RR = 0.96, 95% CI: 0.36-2.53) compared with LND. Six single-arm studies reported 5-year OS and DFS rates of 97% and 94%, respectively, following SLNB alone. The pooled SLNB positivity rate across 13 studies was 8% (95% CI: 5%-12%). Sensitivity analysis confirmed the robustness of the CSS results. Conclusion: This study suggests that SLNB provides oncologic outcomes comparable to LND while reducing surgical morbidity in early-stage cervical cancer. The inclusion of CSS as a validated endpoint reinforces the cancer-specific safety of SLNB, with no significant compromise observed in either OS or PFS. While current evidence is promising, further large-scale prospective trials are needed to refine indications and standardize implementation of SLNB in routine clinical practice.