Abstract
The aim of this study was to compare the tumor-free and overall survival rates between patients with low-risk endometrial cancer who underwent surgical staging and those who did not undergo surgical staging. Data, including demographic characteristics, grade of the tumor, myometrial invasion, cervical involvement, peritoneal washing, lymph node involvement, lymphovascular space invasion, postoperative complication, adjuvant treatment, cancer recurrence, and tumor-free and overall survival rates, for patients with low-risk endometrioid endometrial cancer who were treated surgically with and without pelvic and paraaortic lymph node dissection (LND) were analyzed retrospectively. The patients diagnosed with endometrioid endometrial cancer including the following criteria were considered low-risk: 1) a grade 1 (G1) or grade 2 (G2) endometrioid histology; 2) myometrial invasion of <50% upon magnetic resonance imaging (MRI); 3) no stromal glandular or stromal invasion upon MRI; and 4) no evidence of intra-abdominal metastasis. Then the patients at low-risk were divided into two groups; group 1 (n=117): patients treated surgically with pelvic and paraaortic LND and group 2 (n=170): patients treated surgically without pelvic and paraaortic LND. There was no statistical significance when the groups were compared in terms of lymphovascular space invasion, cervical involvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher in group 2 (p<0.005). The number of patients with positive pelvic nodes and the number of metastatic pelvic nodes were significantly higher in the group with positive LVI than in the group without LVI (p<0.005). No statistically significant differences were detected between the groups in terms of tumor-free survival (p=0.981) and overall survival (p=0.166). Total hysterectomy with bilateral salpingo-oophorectomy and stage-adapted postoperative adjuvant therapy without pelvic and/or paraaortic lymphadenectomy may be safe and efficient treatments for low-risk endometrial cancer.
Highlights
Endometrial cancer is the fourth most common cancer in women after breast, colorectum, and lung cancers in developed countries (Ferlay et al, 2012)
There was no statistical significance when the groups were compared in terms of lymphovascular space invasion, cervical involvement, positive cytology, and recurrence, whereas the administration of an adjuvant therapy was higher in group 2 (p
The International Federation of Gynecology and Obstetrics (FIGO) recommended a surgical procedure for staging the disease, which consists of peritoneal washing, total hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node (PLN) dissection with or without paraaortic lymph node (PALN) dissection (Pecorelli, 2009)
Summary
Endometrial cancer is the fourth most common cancer in women after breast, colorectum, and lung cancers in developed countries (Ferlay et al, 2012). The National Comprehensive Cancer Network (NCCN) accepted PALN dissection as a routine operation in all patients with endometrial cancer (NCCN, 2009). While some studies supported LND to assess the extent of the disease as far as possible and to identify the appropriate adjuvant therapy to improve the outcome (Goudge et al, 2004; Havrilesky et al, 2005; Chan et al, 2007; Singh et al, 2007), others were opposed to LND in patients with a low risk for nodal metastases due to complications, including increased blood loss and operation time, vascular injury, lymphocyst formation, and lymphedema (Homesley et al, 1992; Abu-Rustum et al, 2006), and two randomized trials showed that LND did not affect the progression-free or overall survivals (Benedetti et al, 2008; Kitchener et al, 2009). The definition of low risk is not uniform, despite several studies having investigated the clinicopathological risk factors for lymph node involvement in endometrial cancer (Mariani et al, 2000; Akbayir et al, 2012; Zhang et al, 2012; Kumar et al, 2013; Vargas et al, 2014)
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
