Abstract
Objective: To compare laparoscopic surgery to laparotomy for harvesting para-aortic lymph nodes in presumed stage I–II, high-risk endometrial cancer patients.Methods: Patients with histologically proven endometrial cancer, presumed stage I-II with high-risk tumor features who had undergone hysterectomy, bilateral salpingoophorectomy, or pelvic and para-aortic lymphadenectomy by either laparoscopy or laparotomy in Samsung Medical Center from 2005 to 2017 were retrospectively investigated. The primary outcome was para-aortic lymph node count. Secondary outcomes were pelvic lymph node count, perioperative events, and postoperative complications.Results: A total of 90 patients was included (35 for laparotomy, 55 for laparoscopy) for analysis. The mean (±SD) para-aortic lymph node count was 10.66 (±7.596) for laparotomy and 10.35 (±5.848) for laparoscopy (p = 0.827). Mean pelvic node count was 16.8 (±6.310) in the laparotomy group and 16.13 (±7.626) in the laparoscopy group (p = 0.664). Lower estimated blood loss was shown in the laparoscopy group. There was no difference in perioperative outcome between the groups. Additional multivariate analysis showed that survival outcome was not affected by surgical methods in presumed stage I-II, high-risk endometrial cancer patients.Conclusions: Study results demonstrate comparable para-aortic lymph node count with less blood loss in laparoscopy over laparotomy. In women with presumed stage I-II, high-risk endometrial cancer, laparoscopy is a valid treatment modality.
Highlights
Endometrial carcinoma is the most rapidly increasing female genital tract malignancy
The European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO), and European Society for Radiotherapy and Oncology (ESTRO) guidelines recommend that treatments of high-intermediate risk, high risk, and/or advanced endometrial cancer should include surgical treatment with hysterectomy, bilateral salpingooophorectomy with additional pelvic lymph node dissection (PLND), and para-aortic lymph node dissection (PALND) [3, 4]
We investigated data from electronic medical records and included patients based on the following criteria: [1] histologically confirmation of endometrial cancer, [2] presumed stage I or II [International Federation of Gynecology and Obstetrics (FIGO)], [3] preoperatively evaluated as high-risk tumor [one of following features; non-endometrioid type/endometrioid type FIGO grade 3/endometrioid type FIGO grade 2 with >50% myometrial invasion or invasion in the cervical stroma, evaluated by trans-vaginal ultrasound and/or magnetic resonance imaging (MRI) of pelvis] [10]
Summary
Endometrial carcinoma is the most rapidly increasing female genital tract malignancy. In 2018, it was the sixth most common malignancy in females, accounting for 382,069 new cases worldwide [1]. In Korea, the incidence of newly diagnosed endometrial cancer consistently increased in all age groups from 1999 to 2015 [2]. Endometrial cancer usually occurs in women after menopause, and most cases present with early-stage disease due to frequent symptoms of abnormal vaginal bleeding, which leads to early detection. The European Society for Medical Oncology (ESMO), European Society of Gynaecological Oncology (ESGO), and European Society for Radiotherapy and Oncology (ESTRO) guidelines recommend that treatments of high-intermediate risk, high risk, and/or advanced endometrial cancer should include surgical treatment with hysterectomy, bilateral salpingooophorectomy with additional pelvic lymph node dissection (PLND), and para-aortic lymph node dissection (PALND) [3, 4]. The results of lymphadenectomy provide physicians relevant information for adjuvant treatment in the clinical field
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