What should lymphadenectomy offer in early-stage endometrial cancer: lots of variables, little control

Abstract

c The contemporary view of endometrial cancer suggests that most women, fortunately, have low-risk disease, with a low probability of recurrence following hysterectomy. Identifying the smaller subset of patients with disease spread at presentation or who may benefit from adjuvant therapy remains the challenge. Risk of disease recurrence and survival has been related to simple models evaluating uterine characteristics, nodal status, and use of adjuvant therapy. Additional data based on patient age, tumor histology, and specific type of adjuvant therapy may fine-tune risk models even further. In 2011, the extent of disease spread, or stage, remains the single most important factor for defining use of adjuvant therapy and prognosis. Of the methods to assess disease spread, lymph node dissection is the best technique for identifying the approximately 9% of patients with otherwise unrecognized disease spread. Compared with patients with node negative disease, patients with node-positive disease carry different prognoses and largely receive different therapies. Compared with those patients with unresected/unrecognized positive nodes, those node positive patients treated with lymphadenectomy perhaps achieve better result with the same therapies once use. The use of lymph node dissection as a routine practice or a selective one is the source of considerable debate and active research and largely relates the marginal benefit that may be achieved in a particular population. In the late 1990s to the early 2000s, a paradigm based on increasing use of lymphadenectomy was discussed in the literature. Lymphadenectomy was suggested to be a therapeutic endeavor and could lead to a substitution of vaginal cuff brachytherapy for pelvic radiation therapy. Data also merged suggesting that nodal status could be used as a fulrum; node-negative patients would receive surveillance, ode-positive patients would receive adjuvant therapy. Lymph node status as a single variable, however, probably produces an incomplete picture of disease behavior.