Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis

Papathemelis, Thomas; Hassas, Dunja; Gerken, Michael; Klinkhammer‐Schalke, Monika; Scharl, A.; Lux, Michael P.; Beckmann, M.W.; Scharl, Sophia

doi:10.1007/s00432-018-2715-4

Cited by 9 publications

(5 citation statements)

References 20 publications

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“…Venigalla et al observed an improvement in overall survival after pelvic lymphadenectomy or with no pelvic lymphadenectomy in high-risk cancers [15]. Also, Papathemelis et al in the study in 2017 reported a significant effect of systematic pelvic and paraaortic lymphadenectomy in reduction of recurrence rate and longer overall survival, while in 2018 Papathemelis et al found lower effect of lymphadenectomy in patients with low grade endometrial cancer [16,17]. Konno et al reported studies with no lymphadenectomy in endometrial cancer, which could be preferred in practice.…”

Section: Discussionmentioning

confidence: 99%

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Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Bizoń,

Olszewski,

Grabowska

et al. 2024

JPM

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(1) The surgical method of choice for the treatment of endometrial cancer is minimally invasive surgery. In cases of high-risk endometrial cancer, completed paraaortic and pelvic lymphadenectomy are indicated. The aim of this study was to analyze the types of docking during robotic surgery assisted with the da Vinci X system while performing paraaortic and pelvic lymphadenectomy. (2) Methods: A total of 25 patients with high-risk endometrial cancer, with a mean age of 60.07 ± 10.67 (range 34.69–83.23) years, and with a mean body mass index (BMI) of 28.4 ± 5.62 (range 18–41.5) kg/m2, were included in this study. The analyzed population was divided into groups that underwent single or dual docking during surgery. (3) Results: No statistical significance was observed between single and dual docking during paraaortic and pelvic lymphadenectomy and between the type of docking and the duration of the operation. However, there was a statistically significant correlation between the duration of the operation and previous surgery (p < 0.005). The number of removed lymph nodes was statistically associated with BMI (p < 0.005): 15.87 ± 6.83 and 24.5 ± 8.7 for paraaortic and pelvic lymph nodes, respectively, in cases of single docking, and 18.05 ± 7.92 and 24.88 ± 11.75 for paraaortic and pelvic lymph nodes, respectively, in cases of dual docking. (4) Conclusions: The robot-assisted approach is a good surgical method for lymphadenectomy for obese patients, and, despite the type of docking, there are no differences in the quality of surgery.

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Section: Discussionmentioning

confidence: 99%

“…In this group, only one patient had undergone laparotomy in the past. The mean number of paraaortic lymph nodes was 15.87 (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24) and the mean number of pelvic lymph nodes was 24.5 (14-43). The mean operative time was 177 (110-235) min.…”

Section: Docking and Lymphadenectomymentioning

confidence: 99%

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Bizoń,

Olszewski,

Grabowska

et al. 2024

JPM

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“…The benefit of lymphadenectomy in EC patients has been a controversial topic for over a decade (12)(13)(14). The survival advantage associated with lymphadenectomy exists primarily in patients with a relatively high risk of recurrence (14)(15)(16)(17)(18), and improperly expanding the indication of lymphadenectomy might result in more adverse effects instead (19)(20)(21)(22)(23)(24)(25). Our research didn't support the role of lymphadenectomy in preventing LNR in terms of the scope and number of LNs harvest, with agreement with Mariani et al (5).…”

Section: Discussionmentioning

confidence: 99%

A detailed analysis of lymph node recurrence in endometrial carcinoma

Li¹,

Dong²,

Dai³

et al. 2022

Transl Cancer Res TCR

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Background: The lymph node (LN) is one of the main sites of recurrence in patients with endometrial carcinoma (EC). Literature specifically analyzing LN recurrence (LNR) in EC remains limited in number.Methods: Patients with EC undergoing surgery between 2006 and 2021 in Peking University People's Hospital was included, clinicopathological data of whom were collected and analyzed retrospectively by R 4.0.3.Results: A total of 792 patients were included, with 73 patients having recurrence, among whom 21 patients had LNR. Median recurrence-free survival (RFS) in patients with LNR was 16 [4-39] months. LNR was extensive, with pelvic LNs most commonly involved (9/21). There are various patterns of LNR, with 33.3% (7/21) LN-only recurrence. Multivariable analysis suggested advanced stage, larger tumor diameter and poor histology were independent risk factors for LNR. Patients with LN metastasis (LNM) diagnosed at initial treatment accounted for 47.6% (10/21) of cases with LNR, 60.0% (6/10) of whom had recurrent LNs beyond the region of LNM, 90.0% (9/10) of whom had recurrence nodes overlapping with the range of lymphadenectomy. Uni-and multi-variable analysis suggested lymphadenectomy was not a protective factor for LNR, with both the range and number of LNs harvested considered.Conclusions: LNR is common in patients with EC, with an extensive range and various patterns of recurrence. The International Federation of Gynecology and Obstetrics (FIGO) stage, tumor diameter and histology were independent risk factors for LNR, but lymphadenectomy seemed not a protective factor for LNR.

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“…The patient age, which has been incorporated into the existing risk classification systems [ 5 , 6 ], may influence the effect of lymphadenectomy in endometrioid endometrial carcinoma ( Table 3 ). In elderly women, lymphadenectomy may be less effective than in younger women, which might be indicated in German population-based studies where median age of the patients was 69 years or older [ 127 , 128 ]. This may be explained by the association of older age with adverse pathologic features [ 129 , 130 ], hematogenous dissemination [ 118 ], and immunosenescence [ 131 ].…”

Section: Benefit Of Systematic Lymphadenectomy In Node-negative Patie...mentioning

confidence: 99%

Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy

Otsuka

2022

Cancers

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Endometrial cancer is the most common gynecological tract malignancy in developed countries, and its incidence has been increasing globally with rising obesity rates and longer life expectancy. In endometrial cancer, extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Nevertheless, pelvic lymphadenectomy is not considered to have a therapeutic benefit, as it did not improve survival in randomized studies. However, lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative. Systematic lymphadenectomy may remove undetectable low-volume lymph node metastasis in both pelvic and para-aortic regions, and open surgery may reduce vaginal recurrence even without vaginal brachytherapy. However, lymphadenectomy may not improve survival in elderly patients and patients with p53-mutant tumors. In this review, I discuss the characteristics of lymph node metastasis, the methods of lymph node assessment, and the therapeutic benefits of systematic lymphadenectomy in patients with intermediate- and high-risk endometrioid endometrial carcinoma.

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Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis

Abstract: In contrast to previous observations in high-grade EC, our study provides compelling evidence that LND, in particular systematic lymphadenectomy, is not beneficial for patients with type I FIGO IB EC in terms of long-term OAS and RFS.

Cited by 9 publications

References 20 publications

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

Efficacy of Single- and Dual-Docking Robotic Surgery of Paraaortic and Pelvic Lymphadenectomy in High-Risk Endometrial Cancer

A detailed analysis of lymph node recurrence in endometrial carcinoma

Therapeutic Benefit of Systematic Lymphadenectomy in Node-Negative Uterine-Confined Endometrioid Endometrial Carcinoma: Omission of Adjuvant Therapy

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