A cohort study evaluating paraaortic lymphadenectomy in endometrial cancer

Abstract

Abstract. The current study sought to assess the role of paraaortic lymphadenectomy (LNE) in females with endometrial cancer. A retrospective analysis of patients diagnosed with endometrial cancer of stage IA to II preoperatively, between 2009 and 2011 was conducted. Patients were included who had suffered from endometrial cancer without preoperative adjuvant therapy and who underwent hysterectomy plus systematic pelvic LNE and paraaortic LNE by laparoscopy or laparotomy. A total of 54 patients who underwent surgery for preoperative endometrial cancer were selected. All patients underwent LNE. The incidences of pelvic and paraaortic lymph node metastases were 11.1% (6/54) and 7.4% (4/54), with a total positive lymph node rate of 14.8% (8/54). In addition, among the 8 positive cases, 5 patients underwent laparotomy and 3 underwent laparoscopy; 3 cases were classified as stage I and 5 as stage II preoperatively. Of these, 7 patients were identified with pathology-related risk factors, including low differentiation or clear cell adenocarcinoma postoperatively. Discordance of pathological differentiation between the pre-and postoperative stages reached 57.1% (4/7). The results revealed the high occurrence of positive lymph nodes in endometrial cancer which demonstrate the importance of systematic LNE. Additonally, no severe complications were caused by LNE besides lymph cysts. In summary, it is neccesary to perform LNE, particularly the removal of the paraaortic lymph node, in patients with endometrial cancers in order to improve postoperative therapy. Laparoscopy has similar surgical effects as laparotomy, but has a number of advantages.

Early Predictors of the Endometrium Cancer Recurrence in Our Environment

“…In addition, other risk factors such as obesity, nulliparity, late menopause, diabetes mellitus, high blood pressure, Lopez Gonzalez Elga et al: Early Predictors of the Endometrium Cancer Recurrence in Our Environment family history, diet rich in animal fats and history of pelvic irradiation must be taken into account, since they are crucial for the development of the disease [4]. By now, according to the NCCN guidelines [5], the accepted treatment for endometrial cancer regardless of the stage in which we find ourselves is the performance of total hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy.…”

Prevalencia del compromiso ganglionar en pacientes con cáncer de endometrio, Colombia 2009-2016: análisis exploratorio de factores asociados

“…El papel de la linfadenectomía pélvica o paraaórtica como manejo estandarizado para todas las pacientes es controversial, debido a que la mayoría de las pacientes no tienen compromiso ganglionar y este procedimiento presenta morbilidad entre un 8 a 50 %, con complicaciones intraoperatorias como las lesiones vasculares, o posoperatorias como infección, el linfedema, ileo paralítico, entre otras (10,11). Por ello, la recomendación de varios autores es realizar dicha intervención cuando: a) existen factores que indiquen una alta posibilidad de compromiso ganglionar como: tipo histológico seroso papilar o de células claras, grado histológico III, invasión miometrial mayor del 50 %, invasión linfovascular, tumor mayor de 2 cm, compromiso cervical (11,12); b) cuando se descarte compromiso del ganglio centinela (13)(14)(15); c) imágenes diagnósticas sugestivas de compromiso ganglionar (16,17) o marcadores tumorales preoperatorios positivos (18).…”