Published data were identified by a search of Pubmed, using the term “endometrial cancer” in combination with the terms “node metastases”, “adjuvant radiotherapy”, “intraoperative pathology”, “vascular space invasion”, and “myometrial depth”. Only studies published in English between 1966 and 2006 were included.
ReviewRole of complete lymphadenectomy in endometrioid uterine cancer
Introduction
Uterine corpus cancer is the most common gynaecological malignancy in developed countries.1 Most patients with endometrioid uterine cancer present at an early stage and have a good prognosis, but those with advanced disease have a significantly worse survival. Up to 20% of patients with endometrial cancer relapse and eventually die of their disease. In the USA, the annual number of deaths has increased, with about 3000 in the 1980s, 5000 in the 1990s, and 7000 in more recent years.1 In view of this increase, improvements are needed in the early diagnosis and treatment of this cancer. Previous studies suggest that age, stage, histology, tumour grade, myometrial invasion, and nodal involvement are important prognosticators.2, 3 One of the challenges in defining the optimum surgical treatment of endometrial cancer arises from inconsistencies in staging and, in particular, lymph-node assessment. This review focuses on comparing the benefits and risks of a complete (Figure 1, Figure 2) versus selective lymphadenectomy in patients with endometrioid corpus cancer.
Section snippets
Current practices around the world
In 1988, the staging of endometrial uterine cancer was changed from clinical to surgical staging, including pelvic and para-aortic lymphadenectomy on the basis of the International Federation of Gynaecologists and Obstetricians (FIGO) criteria.4 The role of comprehensive surgical staging, especially pelvic and para-aortic lymphadenectomy for all patients, remains controversial. Because of the lack of consistency in recommendations, the surgical treatment of endometrial cancer in academic and
Inaccuracies of preoperative and intraoperative assessment
Several investigators have advocated the use of preoperative or intraoperative pathological assessment of histological grade and depth of invasion, on the basis of gross inspection or frozen section, to identify patients at risk of nodal metastases who might benefit from a lymphadenectomy. However, most studies have shown that about 30% of tumours with preoperative grade 1 histology have a postoperative histological diagnosis indicating a higher risk for metastatic disease and, therefore, these
Prognostic relevance of positive lymph nodes
Surgical staging remains the most precise method for identifying nodal metastases. Standardised surgical staging provides prognostic information and helps formulate comparative assessments. Because lymph-node spread represents the most common site of extrauterine disease in endometrial cancer, identification of patients with nodal metastases is important for providing guidance on prognosis and adjuvant treatment. A review of 1109 patients with clinical stage I–II endometrial uterine cancer
Improved likelihood of finding a positive lymph node
Although complete lymphadenectomy is the standard of care in women with cervical and vulvar cancers, the role of a complete lymphadenectomy remains controversial in endometrioid uterine cancer. Because lymph-node metastasis is an important prognostic factor, adequate lymph-node dissection needs to be done to ensure a high probability of detecting a positive node. Previous studies have used arbitrary numbers to define such an adequate nodal dissection. Single institutional studies have claimed
Conclusion
Although complete lymph-node dissection should be used for most patients with endometrioid uterine cancer, those with low-risk disease might not benefit from lymphadenectomy. However, given the restrictions of preoperative and intraoperative pathological analyses, the role of lymphadenectomy in low-risk patients might still have merit. A complete lymphadenectomy provides prognostic information and directs the use of appropriate adjuvant treatment in node-positive patients. Additionally, it can
Search strategy and selection criteria
References (81)
- et al.
An analysis of approaches to the management of endometrial cancer in North America: a CTF study
Gynecol Oncol
(1998) - et al.
An analysis of approaches to the treatment of endometrial cancer in western Europe: a CTF study
Eur J Cancer
(1995) - et al.
Surgical management of endometrial cancer in Slovak Republic
Eur J Surg Oncol
(2006) - et al.
Endometrial cancer–revisiting the importance of pelvic and para aortic lymph nodes
Gynecol Oncol
(2007) - et al.
Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma
Lancet
(2000) - et al.
Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary?
Am J Obstet Gynecol
(2000) - et al.
Nodal distribution and its significance in FIGO stage IIIc endometrial cancer
Gynecol Oncol
(2001) - et al.
Pelvic lymphadenectomy in the surgical treatment of endometrial cancer
Gynecol Oncol
(1993) - et al.
Prospective evaluation of FDG-PET for detecting pelvic and para-aortic lymph node metastasis in uterine corpus cancer
Gynecol Oncol
(2004) - et al.
Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: a Gynecologic Oncology Group study
Gynecol Oncol
(1991)
Carcinoma of the corpus uteri
Int J Gynaecol Obstet
A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: a Gynecologic Oncology Group study
Gynecol Oncol
Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling
Gynecol Oncol
Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma
Gynecol Oncol
Lymph node sampling and survival in endometrial cancer
Gynecol Oncol
Good outcome associated with a standardized treatment protocol using selective postoperative radiation in patients with clinical stage I adenocarcinoma of the endometrium
Gynecol Oncol
Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial
Int J Radiat Oncol Biol Phys
The outcomes of 27,063 women with unstaged endometriod cancer
Gynecol Oncol
Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer
Gynecol Oncol
Efficacy of systematic lymphadenectomy and adjuvant radiotherapy in node-positive endometrial cancer patients
Gynecol Oncol
Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology
Gynecol Oncol
Staging and therapeutic value of lymphadenectomy in endometrial cancer
Gynecol Oncol
Stage IC adenocarcinoma of the endometrium: survival comparisons of surgically staged patients with and without adjuvant radiation therapy
Gynecol Oncol
Patterns of failure in endometrial carcinoma stage IB grade 3 and IC patients treated with postoperative vaginal vault brachytherapy
Gynecol Oncol
Local recurrence in high-risk node-negative stage I endometrial carcinoma treated with postoperative vaginal vault brachytherapy
Gynecol Oncol
Long-term survival of intermediate risk endometrial cancer (stage IG3, IC, II) treated with full lymphadenectomy and brachytherapy without teletherapy
Gynecol Oncol
Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma
Obstet Gynecol
Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer
Int J Radiat Oncol Biol Phys
Pelvic and para-aortic lymphadenectomy for surgical staging of high-risk endometrioid adenocarcinoma of the endometrium
Gynecol Oncol
Analysis of FIGO Stage IIIc endometrial cancer patients
Gynecol Oncol
Surgery without radiotherapy for primary treatment of endometrial cancer
Obstet Gynecol
Staging laparotomy for endometrial carcinoma: assessment of retroperitoneal lymph nodes
Gynecol Oncol
Endometrial cancer with para-aortic adenopathy: patterns of failure and opportunities for cure
Int J Radiat Oncol Biol Phys
Resection of lymph node metastases influences survival in stage IIIC endometrial cancer
Gynecol Oncol
The incidence of symptomatic lower-extremity lymphedema following treatment of uterine corpus malignancies: a 12-year experience at Memorial Sloan-Kettering Cancer Center
Gynecol Oncol
Adenocarcinoma of the endometrium treated with combined irradiation and surgery: study of 437 patients
Int J Radiat Oncol Biol Phys
Audit of preoperative and early complications of laparoscopic lymph node dissection in 1000 gynecologic cancer patients
Am J Obstet Gynecol
Endometrial carcinoma: paraaortic dissemination
Gynecol Oncol
A comparison of treatment strategies for endometrial adenocarcinoma: analysis of financial impact
Gynecol Oncol
Twelve-year experience in the management of endometrial cancer: a change in surgical and postoperative radiation approaches
Gynecol Oncol
Cited by (101)
Lymphadenectomy for high-grade endometrial cancer: Does it impact lymph node recurrence?
2022, European Journal of Surgical OncologyCitation Excerpt :Furthermore, routine para-aortic lymphadenectomy was not performed in either study and lymphadenectomy was not performed systematically as demonstrated by the low lymph node count (<9) in up to 35% of patients [3,4]. While several retrospective studies have reported no survival benefit with lymphadenectomy in low-risk endometrial cancer [5–7,20] several large retrospective studies have shown a survival advantage of lymphadenectomy in high-risk endometrial cancer subtypes [5–10,21]. The SEPAL study showed that performing a pelvic and para-aortic lymphadenectomy in intermediate and high-risk patients resulted in significantly longer overall and recurrence-free survival [6].
N<sup>o</sup> 291 - Épidémiologie et explorations visant la présence soupçonnée d'un cancer de l'endomètre
2018, Journal of Obstetrics and Gynaecology CanadaNo. 291-Epidemiology and Investigations forSuspected Endometrial Cancer
2018, Journal of Obstetrics and Gynaecology CanadaLaparoscopic technique of para-aortic lymph node dissection: A comparison of the different approaches to trans- versus extraperitoneal para-aortic lymphadenectomy
2017, Gynecology and Minimally Invasive TherapyÉpidémiologie et explorations visant la présence soupçonnée d'un cancer de l'endomètre
2016, Journal of Obstetrics and Gynaecology CanadaA Review of Laparoscopic Para-aortic Lymphadenectomy for Early-stage Endometrial Cancer: Extraperitoneal Approach May Have the Advantage over Intraperitoneal Approach
2024, Gynecology and Minimally Invasive Therapy