Should all endometrioid uterine cancer patients undergo systemic lymphadenectomy?

Abstract Objective To evaluate the potential benefits of systemic pelvic and para-aortic lymphadenectomy in endometrioid uterine cancer patients. Methods We conducted a retrospective study on 244 cases of endometrioid uterine cancer that involved surgery in the Center of Gynecologic Oncology, Peking...

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Bibliographic Details
Published in:European journal of surgical oncology 2013-04, Vol.39 (4), p.344-349
Main Authors: Wang, Z.-Q, Wang, J.-L, Shen, D.-H, Li, X.-P, Wei, L.-H
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Carcinoma, Endometrioid - epidemiology
Carcinoma, Endometrioid - secondary
Carcinoma, Endometrioid - surgery
China - epidemiology
Disease-Free Survival
Endometrial Neoplasms - epidemiology
Endometrial Neoplasms - pathology
Endometrial Neoplasms - surgery
Endometrioid carcinoma
Female
Hematology, Oncology and Palliative Medicine
Humans
Lymph Node Excision - adverse effects
Lymphadenectomy
Lymphatic Metastasis
Middle Aged
Multivariate Analysis
Neoplasm Staging
Prognosis
Proportional Hazards Models
Retrospective Studies
Staging
Surgery
Survival Analysis
Uterine cancer
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Summary:Abstract Objective To evaluate the potential benefits of systemic pelvic and para-aortic lymphadenectomy in endometrioid uterine cancer patients. Methods We conducted a retrospective study on 244 cases of endometrioid uterine cancer that involved surgery in the Center of Gynecologic Oncology, Peking University People's Hospital, Beijing, from January 2000 to May 2008. We conducted staging for each case to ensure accordance with FIGO 2009 surgical staging criteria. Clinical data, including histology, age at diagnosis, surgical procedure, adjuvant therapy, date of death or last follow-up, and date and sites of recurrence were collected for each patient. Results Among 244 endometrioid uterine cancer patients, 207 cases (84.8%) underwent systemic pelvic lymphadenectomy. Among these cases, pelvic lymph nodes in 17 cases (8.2%) exhibited tumor metastasis. Systemic aortic lymphadenectomy was performed in 127 cases (52.0%) among 244 total patients. Five cases (3.9%) exhibited positive aortic lymph nodes, of which four exhibited positive pelvic lymph nodes. We investigated the impact of positive retroperitoneal lymph nodes on staging: 4 (4/161, 2.5%), 6 (6/29, 20.7%), 6 (6/35, 17.1%), 1 (1/8) and 1 (1/6) case changed to stage IIIc from stage Ia, Ib, II, IIIa, and IIIb, respectively. Tumor-free and overall survival did not differ between patients who underwent pelvic lymphadenectomy or not ( P  > 0.05). Tumor-free survival improved in stage Ib pelvic lymphadenectomy patients ( P  = 0.040); para-aortic lymphadenectomy did not improve patient survival in all stages ( P  > 0.05). Conclusion Systemic lymphadenectomy is not warranted in stage Ia endometrioid uterine cancer.
ISSN:0748-7983
1532-2157
DOI:10.1016/j.ejso.2012.12.007