Abstract
Objective: To determine the indication for lymph node dissection in patients with endometrial cancer, we investigated the incidence and distribution of single metastatic lymph nodes in patients who underwent systematic pelvic and para-aortic lymph node dissection.Methods: This study involved 910 patients with endometrial cancer who were treated at the Cancer Institute Hospital, Japan, between January 1994 and December 2015. All patients underwent an open hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph nodes dissection.Results: Lymph node metastasis was observed in 199 patients (21.9%), 45 (5%) of whom had single lymph node metastasis. Single lymph node metastasis accounted for 22.6% of all metastatic cases. Myometrial invasion >50% was observed in 30 patients, whereas 15 patients had <50% myometrial invasion. When mapping single lymph node metastatic sites, the para-aortic area had a frequency of 31.1% (14 cases). The distribution of single metastatic lymph nodes spanned a wide area between the pelvic and para-aortic regions. Considering single metastatic nodes and myometrial invasion, 8 patients (53.3%) who had myometrial invasion <50% had a single metastatic node in the para-aortic region. Four of 9 patients (45%) considered low-risk (endometrioid Grade 1-2, invasion depth <50%, no lymphovascular space invasion) showed metastasis to the para-aortic areas.Conclusion: Single metastatic lymph nodes were widely distributed between the pelvic and para-aortic regions, suggesting that detection of a sentinel lymph node in patients with endometrial cancer could be problematic.
Highlights
In Japan, amongst gynecological malignancies, the incidence of endometrial cancer is increasing at the fastest rate
Of the 199 patients who had positive lymph nodes, a single metastatic node was observed in 45 patients (5.0%), 2 metastatic nodes were seen in 24 patients, 3 metastatic nodes were noted in 19 patients, and ≥ 4 metastatic nodes were found in 111 patients
Altay et al [8] reported that the rate of isolated para-aortic metastasis was 4% among 173 patients with endometrial cancer and that the low precaval region had the highest frequency of single metastatic node distribution
Summary
In Japan, amongst gynecological malignancies, the incidence of endometrial cancer is increasing at the fastest rate. Based on our institutional experience, the majority of patients with endometrial cancer are diagnosed with earlystage disease (International Federation of Gynecology and Obstetrics (FIGO) I and II) without clinical evidence of extrauterine spread, and most had excellent 5-year survival rates (stage I, 97.5%; stage II, 93.9%). Patients with FIGO stage III endometrial cancer, who accounted for 10–15% patients, had inferior 5-year survival rates (82.9%). Lymph node metastasis is an important prognosticator in patients with endometrial cancer, and detection of lymph node transitions requires systematic dissection, including pelvic and para-aortic lymph nodes. For patients with endometrial cancer, the SLN procedure has been evaluated recently its acceptance remains controversial [2,3]. SLN patterns in patients with endometrial cancer are influenced by injection site; there are a variety of SLN mapping results
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