Abstract
Objective:We aimed to analyze variables affecting lymph node (LN) involvement and to assess the need for systematic lymphadenectomy in patients with endometrial cancer (EC).Materials and Methods:A single centre retrospective analysis was conducted in a total of 128 consecutive patients with EC who underwent systematic pelvic or combined pelvic and paraaortic lymphadenectomy between 2009 and 2012. Mann-Whitney U, chi-square, and Fisher’s exact test were used for univariate analyses when appropriate. Variables with a p value <0.05 in the univariate analysis were included into a multivariate logistic regression analysis. The effects of variables on LN involvement are reported using adjusted odds ratios (ORs) and 95% confidence intervals (CI).Results:In univariate analysis, grade 2-3, tumor size ≥3 cm, deep (≥50%) myometrial invasion, presence of cervical, adnexal or omental involvement, positive peritoneal cytology, open surgical approach (laparotomy), combined pelvic and paraaortic lymphadenectomy and number of total LNs removed (>30) were found associated with LN involvement. However, the number of total LNs removed (>30) was the only independent variable that predict LN involvement in multivariate analysis [OR: 15.08; 95% CI: (1.28-177.59); p=0.03].Conclusion:This study demonstrates that the more LNs removed during staging of EC, the greater the probability of finding LN metastasis.
Highlights
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries
This study demonstrates that the more lymph node (LN) removed during staging of endometrial cancer (EC), the greater the probability of finding LN metastasis
A systematic lymphadenectomy is an essential part of staging surgery, Federation of Gynecology and Obstetrics (FIGO) did not define the optimal limits for lymphadenectomies, nor the adequate number of LNs required for the comprehensiveness of the procedure
Summary
Endometrial cancer (EC) is the most common gynecologic malignancy in developed countries. Its age-adjusted incidence is increasing, probably due to increased life expectancy and obesity. The mortality rate has increased more rapidly than the incidence over the past three decades[1]. One explanation for this discrepancy is that patients are being diagnosed at an older age, which leads to an increased rate of high-risk histologies and advanced-stage cancers. EC is staged surgically based on the International Federation of Gynecology and Obstetrics (FIGO) 2009 staging system[2]. A systematic lymphadenectomy is an essential part of staging surgery, FIGO did not define the optimal limits for lymphadenectomies, nor the adequate number of LNs required for the comprehensiveness of the procedure.
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