Lymphadenectomy in endometrial cancer: when, not if

Abstract

The lack of consensus for primary surgical treatment of endometrial cancer, the most common gynaecological cancer, is deplorable. Whether lymphadenectomy should be done together with hysterectomy has been debated at length and passionately. Resolution of this problem has been confounded by several issues, such as selection of patients, the perceived goals of lymphadenectomy, and clinicians' failure to recognise the known routes of lymphatic spread from the uterus. 1 Bakkum-Gamez JN Gonzalez-Bosquet J Laack NN Mariani A Dowdy SC Current issues in the management of endometrial cancer. Mayo Clin Proc. 2008; 83: 97-112 Summary Full Text Full Text PDF PubMed Scopus (115) Google Scholar In practice, lymphadenectomy varies from complete omission, to various iterations of lymph-node sampling, to systematic lymphadenectomy. Furthermore, the extent of lymphadenectomy ranges from pelvic-node dissection alone to dissection of the para-aortic area, which can include the aortic bifurcation to the inferior mesenteric artery and up to the renal vessels. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysisCombined pelvic and para-aortic lymphadenectomy is recommended as treatment for patients with endometrial carcinoma of intermediate or high risk of recurrence. If a prospective randomised or comparative cohort study is planned to validate the therapeutic effect of lymphadenectomy, it should include both pelvic and para-aortic lymphadenectomy in patients of intermediate or high risk of recurrence. Full-Text PDF