Challenges Posed by Embryonic and Anatomical Factors in Systematic Lymphadenectomy for Endometrial Cancer

Abstract

Lymph node involvement has been shown to be one of the most relevant prognostic factors in a variety of malignancies; this is also true of endometrial cancer. The determination of the lymph node status is crucial in order to establish the tumor stage, and to consider adjuvant treatment. A wide range of surgical staging practices are currently used for the treatment of endometrial cancer. The necessity and extent of lymph node dissection is an ongoing controversial issue in gynecological oncology. Lymph node surgery in endometrial cancer is technically challenging, and can be time consuming because of the topographic complexity of lymphatic drainage as such, and the fact that the lymph nodes are directly adjacent to both blood vessels and nerves. Therefore, profound and exact knowledge of the anatomy is essential. Sentinel lymph node mapping was recently introduced in surgical staging with the aim of reducing morbidity, whilst also obtaining useful prognostic information from a patient’s lymph node status. The present review summarizes the current evidence on the role of lymph node surgery in endometrial cancer, focusing on the embryological, anatomical, and technical aspects.

Molecular Basis of Endometriosis and Endometrial Cancer: Current Knowledge and Future Perspectives

“…As treatment of endometrial cancer was based on histological characteristics and staging [170,171], prognosis was not promising, especially if the stage is advanced [172][173][174]. Therefore, in the last couple of years, efforts have been directed to molecular aberrations within the specific tumor, as a novel biological targeted therapy with promising outcomes in clinical trials [175].…”

Contemporary Fertility-Sparing Management Options of Early Stage Endometrioid Endometrial Cancer in Young Nulliparous Patients

“…When a diagnosis of EC is established, the disease is localized in 67% of patients, while 20% of women will have regional and 9% distant metastasis [ 8 ]. Management of EC comprises total hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymph node dissection/biopsy [ 8 , 70 , 72 , 75 , 76 , 77 ]. However, because EC is increasingly affecting younger women, this approach is not appropriate for reproductive-age patients.…”

Impact of lymphadenectomy on short- and long-term complications in patients with endometrial cancer

“…Thus, adverse outcomes directly caused by lymph node dissection, such as lymphedema, were reduced from 15.3% after axillary lymph node dissection to 3.3% after sentinel node biopsy [4]. Ongoing research has been focused on reducing the extent of treatment in endometrial cancer, despite clear differences between the lymphatic drainage of the uterus and that of the mammary glands [6].…”