Para-aortic Lymphadenectomy in the Management of Preoperative Grade 1 Endometrial Cancer Confined to the Uterine Corpus

Abstract

Background. The aim of this study was to determine the risk of para-aortic lymph node metastasis in surgically staged patients presenting with preoperative grade 1 endometrial cancer and to assess the impact of para-aortic lymphadenectomy. Materials and methods. A total of 131 consecutive patients diagnosed with preoperative grade 1 endometrial cancer from 2004 to 2009 were analyzed. We included women with endometrial cancer that was thought preoperatively to be confined to the uterine corpus, and all patients had complete staging operation including total hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings, pelvic lymphadenectomy, and para-aortic lymphadenectomy.Results. Of 131 patients, 6 (4.6%) had positive para-aortic lymph nodes and only 2 (1.5%) had isolated para-aortic nodal metastasis with negative pelvic nodes. In comparison of preoperative and postoperative histology, 6.8% of patients were upgraded, with 5.3% grade 2 and 1.5% grade 3. Advanced stage disease was found in 12.9%. Deep myometrial invasion by MRI and CA 125 levels of C31 U/ ml were found to be independent preoperative risk factors for para-aortic lymph node metastasis. Conclusions. Some patients with preoperative grade 1 endometrial cancer are found to have upgraded disease and para-aortic nodal metastasis. Para-aortic lymphadenectomy should be considered in patients presenting with preoperative grade 1 endometrial cancer, especially in the setting of preoperative CA 125 levels of [31 U/ml and deep myometrial invasion by MRI.

Clinicopathological Risk Factors for Pelvic Lymph Node Metastasis in Clinical Early-Stage Endometrioid Endometrial Adenocarcinoma

“…13,14 Patients at low-risk could have isolated PALN involvement, without concurrent pelvic node metastasis. 15 Todo et al 16 demonstrated that PALN dissection had a survival benefit for the intermediate and high-risk cases. However, PALN dissection failed to show any survival advantage in the low-risk patients.…”

Comprehensive Staging Surgery Including Complete Pelvic and Para-Aortic Lymphadenectomy Followed by Adjuvant Vaginal Brachytherapy Improves Survival Rates for Intermediate-Risk Endometrial Cancer Patients

“…In this study, however, the threshold for considering a staging complete is a lymph node count ≥20 with systematic para-aortic lymphadenectomy up to the renal vessels. As indicated in our previous study and in other studies, pelvic and para-aortic lymphadenectomy should be performed in all patients with endometrial cancer, because the preoperative grade 1 endometrial cancer is found to have upgraded disease and with para-aortic nodal metastasis, especially in the setting of preoperative CA-125 levels of ≥31 U/ml and deep myometrial invasion by magnetic resonance imaging [35]. Also there is no reliable preoperative and intraoperative evaluation to predict low-risk disease [36].…”

Diagnostic accuracy of preoperative tests for lymph node status in endometrial cancer: a systematic review

“…Yoon et al [ 45 ] staged 131 low-risk patients with endometrial cancer. All patients were preoperatively presumed to be grade 1, stage 1 and histologically confirmed as endometrioid carcinoma.…”