Systematic lymphadenectomy for intermediate risk endometrial carcinoma treatment does not improve the oncological outcome

Abstract

Objective To evaluate the indication and performance of systematic lymphadenectomy (SL) in Stage I endometrioid endometrial carcinoma (EEC), at intermediate risk (FIGO IAG2/G3, IBG1/G2) on recurrence, disease-free survival (DFS) and survival. Study design 194 women underwent hysterectomies by laparotomy, with SL (n = 95) or without SL (n = 99) between 1990 and 2014 was evaluated. Diagnosis period, age, BMI, comorbidities, stage, and adjuvant radiotherapy were analyzed. DFS and cancer-specific survival were analyzed by Kaplan-Meier and log-rank test, and recurrences by Cox regression. Results SL was performed in 93% (41/44) of women managed before 1998 and decreasing after that (p < 0.001). SL was also more frequent if BMI under 35.0 kg/m 2 (p < 0.001) and in women without comorbidities (p = 0.017). Distribution of age, stage and postoperative radiotherapy were not different between groups. There were 14 recurrences (7.4%), concentrated in the SL group (12 cases) and associated with Stage IAG3 (35.7%, p = 0.009). Longitudinal evaluation exhibited 95% of 5-year cancer-specific survival rate for non-SL group vs. 88% for the SL group (p = 0.039), and DFS rate was 97% for the non-SL group vs. 85% for the SL group (p = 0.004). Cox regression analyses exhibited Stage IAG3 (HR 6.48, IC95% 1.88–22.39; p = 0.003) associated with less DFS. Conclusion SL in surgical staging of EEC at intermediate risk presented no benefits regarding recurrences, DFS, and cancer-specific survival rate when compared to patients not submitted to complete surgical staging. Stage IAG3 had poor prognosis regardless treatment modality. Our results provide further evidence to support the current trend to avoid SL in the surgical approach to selected women.

Impact of Lymphadenectomy on Short- and Long-term Complications in Patients With Endometrial Cancer

“…This is in line with other studies, in which a mere 15-20 % of patients had positive lymph nodes after lymphadenectomy [27]. Muallem [11,29]. The latter authors registered no bene t in regard of disease-free or overall survival in patients with intermediate-risk endometrial carcinoma who had undergone a systematic lymphadenectomy.…”

“…The most common complications of systematic lymphadenectomy are intraoperative bleeding, injury to neighboring organs, postoperative lymph cysts (up to 34.5% of the cases), and lower-limb edema [9,10]. Since more than a half of the patients undergoing a lymphadenectomy (LD) do not have lymph node metastases, the procedure may not improve survival [11][12][13]. The technique of sentinel node biopsy has been re ned over the last few years [14][15][16].…”

Substantial Lymphovascular Space Invasion Is an Adverse Prognostic Factor in High-Risk Endometrial Cancer

“…Here, we found that both LVSI status and recurrence rate were largely similar among patients with stage I/II disease regardless of whether surgical lymph node staging was performed. The similarity in recurrence rates suggests that clinical staging is relatively accurate, consistent with the results of 2 large randomized trials involving patients who underwent systematic pelvic lymphadenectomy 23,24. We did find a significant risk for local recurrence for patients with focal LVSI in stage I/II pN0.…”

Surgicopathological outcomes and survival in carcinoma body uterus: A retrospective analysis of cases managed by laparoscopic staging surgery in Indian women

“…Lymphadenectomy in endometrial carcinoma is a controversial aspect of surgical staging, with many prospective studies negating any therapeutic benefits. [ 16 17 ] However, we performed systematic pelvic lymphadenectomy in all cases and coupled it with para-aortic lymphadenectomy in high-risk cases. The median number of pelvic and para-aortic lymph nodes was comparable to studies in existing literature.…”