Should lymphadenectomy be performed in early stage I and II sarcomas of the corpus uteri

The aim of this study was to investigate the impact of radical lymphadenectomy as a prognostic factor in the management of uterine sarcomas.

Sixty patients with histologically-proven uterine sarcomas were recruited for this study. The patients were evaluated retrospectively, during the time period from September 1990 to June 2008, in the Department of Obstetrics and Gynecology of Aschaffenburg Clinic in Germany. The normality of the quantitative variables was tested using the Kolmogorov-Smirnov test.

Of 60 patients, 35 (58.3%) underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic or para-aortic lymphadenectomy. The excision of iliac nodes was the strongest and most independent factor (β = 0.64, P = 0.000) associated with survival. Recurrence of disease developed in 14 out of 25 patients (56%) who did not receive lymphadenectomy, but in only 10 out of 35 patients (29%) who underwent lymphadenectomy. The mean survival in years after surgery plus lymphadenectomy was 5.28 years, while in patients who did not undergo lymphadenectomy it was 1.56 years.

Removal of lymphatic tissue in patients with early-stage uterine sarcoma significantly decreases the recurrence rate of the disease and improves the postoperative survival. However, there is a need for further prospective randomized controlled trials to investigate the adequate surgical management of uterine sarcomas and to clarify the prognostic value of lymphadenectomy at the initial surgery.