<p>Effect of Pelvic Lymphadenectomy on Survival in Patients with Low-Risk Early-Stage Endometrial Cancer Diagnosed Intraoperatively Using Frozen Tissue Sections: A Retrospective Analysis</p>

Abstract

Purpose To determine whether pelvic lymphadenectomy improved survival in patients diagnosed with low-risk early-stage endometrial cancer by intraoperative pathology. Methods This retrospective analysis included 238 patients at our hospital. Results The lymphadenectomy and non-lymphadenectomy groups contained 121 and 117 patients, respectively. In both groups, more than half the patients had tumor size ≥2 cm, and most had myometrial invasion <50%, stage Ia disease and no lymphovascular space invasion. Age, tumor size, myometrial invasion, surgical-pathologic stage and postoperative adjuvant therapy use were comparable between groups. The non-lymphadenectomy group had more patients treated laparoscopically (36.8% vs 10.7%; P <0.001) and fewer patients with histologic grade 2 disease (35.9% vs 62.8%; P <0.001) than the lymphadenectomy group. In the non-lymphadenectomy group, intraoperative frozen section pathology disagreed with postoperative pathology in only 31/117 cases for histologic grade (none upgraded to grade 3), 1/117 cases for myometrial invasion (one case revised from <50% to ≥50%) and 3/117 cases for surgical-pathologic stage (upgraded from Ia to Ib or II). Disease recurrence rate and overall survival did not differ significantly between the lymphadenectomy and non-lymphadenectomy groups. In multivariate Cox regression analysis, only surgical-pathologic stage >Ia (odds ratio, 47.7; 95% confidence interval, 6.7–340.8; P =0.031) was associated with increased odds of disease recurrence. Conclusion Pelvic lymphadenectomy may not be necessary in patients with an intraoperative diagnosis of low-risk endometrial cancer.

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

“…This is in line with our and the previously presented data, which indicate that the systematic lymphadenectomy does not improve overall survival rates. Further studies have also shown that lymph node dissection does neither improve overall survival nor progression-free survival in patients with endometrial cancer [13,32,33]. Benedetti et al observed an overall survival rate of 85.9% in patients who underwent a lymphadenectomy versus 81.7% in patients without lymphadenectomy.…”

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

“…This is in line with our data, which indicated that systematic lymphadenectomy does not improve overall survival rates. Further studies have also shown that lymph node dissection does neither improve overall survival nor progression-free survival in patients with endometrial cancer [13,31,32]. Benedetti et al observed an overall survival rate of 85.9 % in patients who underwent a lymphadenectomy versus 81.7 % in patients without lymphadenectomy.…”