Staging for endometrial cancer: The controversy around lymphadenectomy – Can this be resolved?

Abstract

Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 FIGO classification.Radiological examination such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming more and more valuable to exclude lymph node metastasis in low risk groups and biomarkers could help to identify patients with high risk lymph node metastatic probability.The therapeutic role of lymph node dissection remains debated. Several endpoints can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer.Firstly, we compare survival according to the realization, the extent and the numbers of nodes removed during lymphadenectomy. Secondly, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Thirdly, we analyze the surgical complication rate after pelvic lymphadenectomy.

Risk of empty lymph node packets in sentinel lymph node mapping for endometrial cancer using indocyanine green

“…Nodal metastasis is an important prognostic factor for patients with endometrial cancer 8. Though the risk of nodal metastasis is small in patients with low-grade tumors, the implications of missing a nodal metastasis due to misidentification of a lymph node are significant.…”

Impact of age on surgical staging and approaches (laparotomy, laparoscopy and robotic surgery) in endometrial cancer management

“…especially in high-risk endometrial cancer, more frequent in elderly (29) (30). There is still a need of randomised control trials but the literature data suggests it could be beneficial mostly in a frailty population Sentinel lymph node biopsy could resolved the question of node status in endometrial cancer because answers lymph node involvement with fewer morbidity (31) (32).…”

National Cancer Database Report of Lymphadenectomy Trends in Endometrial Cancer

“…However, a main critique of this study is that the rate of adjuvant therapy varied dramatically with 77% receiving chemotherapy in the pelvic and para-aortic LNS cohort versus 45% in those receiving only pelvic LNS. 24 Two RCTs have examined the role of LNS in endometrial cancer. The ASTEC trial randomized 1408 patients with endometrial cancer to undergo systemic LNS or no systemic LNS.…”