Role of lymphadenectomy in intermediate-risk endometrial cancer: a matched-pair study

Abstract

ObjectiveTo assess the impact of lymph node dissection (LND) on morbidity, survival, and cost for intermediate-risk endometrial cancers (IREC).MethodsA multicenter retrospective cohort of 720 women with IREC (endometrioid histology with myometrial invasion <50% and grade 3; or myometrial invasion ≥50% and grades 1–2; or cervical involvement and grades 1–2) was carried out. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched pair analysis identified 178 pairs (178 with LND and 178 without it) equal in age, body mass index, co-morbidities, American Society of Anesthesiologist score, myometrial invasion, and surgical approach. Demographic data, pathology results, perioperative morbidity, and survival were abstracted from medical records. Disease-free survival (DFS) and overall survival (OS) was analyzed using Kaplan-Meier curves and multivariate Cox regression analysis. Cost analysis was carried out between both groups.ResultsBoth study groups were homogeneous in demographic data and pathologic results. The mean follow-up in patients free of disease was 61.7 months (range, 12.0–275.5). DFS (hazard ratio [HR]=1.34; 95% confidence interval [CI]=0.79–2.28) and OS (HR=0.72; 95% CI=0.42–1.23) were similar in both groups, independently of nodes count. In LND group, positive nodes were found in 10 cases (5.6%). Operating time and late postoperative complications were higher in LND group (p<0.05). Infection rate was significantly higher in no-LND group (p=0.035). There were no statistical differences between both groups regarding operative morbidity and hospital stay. The global cost was similar for both groups.ConclusionSystematic LND in IREC has no benefit on survival, although it does not show an increase in perioperative morbidity or global cost.

The role of lymph node dissection in endometrial cancer: a systematic scoping review.

“…Para-aortic LND and the use of adjuvant therapies was left to the discretion of the clinician, both of which may have influenced metastasis and therefore survival. A recent matched-pair study that focussed specifically on intermediate risk patients supported the findings of Benedetti et al with the addition that post-operative morbidity was similar in both groups (30) . Although a risk stratification system similar to ESMO-ESGO-ESTRO 2016 was adopted, cervical involvement was considered as an additional defining feature (35) .…”

“…Furthermore, across all risk groups, surgery-related adverse effects of LND must not be ignored (29) . Specifically in the intermediate risk group, postoperative complications such as lymphocyst formation and lower-limb lymphoedema were significantly higher in the LND group (30)(31)(32) . Interestingly however, infection rates were higher in unstaged patients, perhaps because non-surgical infections were also included (30) .…”

“…A matched-pair retrospective study highlighted that a low proportion of intermediate-risk patients who underwent LND had positive LNs compared to unstaged patients (30) . Furthermore, across all risk groups, surgery-related adverse effects of LND must not be ignored (29) .…”

“…LND is not beneficial in advanced EC. LND may be omitted for non-bulky advanced EC patients receiving appropriate adjuvant therapy (30) . There is no consensus regarding the treatment of stage IVB EC (31) .…”

Development and validation of prognostic factors for lymph node metastasis in endometrial cancer: A SEER analysis

“…Nevertheless, there is an ongoing debate concerning practicality of lymphadenectomy. Some studies have shown that traditional lymphadenectomy may not improve DFS or overall survival, while other studies have suggested the opposite [13][14][15] . Therefore, it is crucial to distinguish patients with low risk of LNM from those with high risk.…”