Evaluation of The Efficacy of Systematic Pelvic Lymphadenectomy in Endometrial Cancer

Abstract

Evaluation of: The ASTEC Study Group: Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet 373, 125–136 (2009). Pelvic lymph node metastasis is one of the most common causes of extrauterine tumor spread in early-stage endometrial uterine cancer. Many retrospective studies have shown the significance of pelvic lymphadenectomy in patients with what was suspected preoperatively to be early-stage endometrial carcinoma. The study evaluated here is the largest prospective randomized trial evaluating pelvic lymphadenectomy in early-stage endometrial cancer, and provides the direct and fully reported overall and recurrence-free survival rates comparing standard surgery with standard surgery plus pelvic lymphadenectomy in patients with early-stage endometrial carcinoma. Overall, the results showed no evidence of benefit in terms of overall or recurrence-free survival for pelvic lymphadenectomy in women with early-stage endometrial cancer. However, this trial analyzed the results of overall and recurrence-free survival without considering the combination of histopathological prognostic risk factors. It may be important to analyze overall and recurrence-free survival between the subgroups by combination of the histopathological prognostic risk factors. A large, prospective clinical trial might be necessary to evaluate the role of pelvic lymphadenectomy by considering the combination of histopathological prognostic risk factors in early-stage endometrial cancer.