The prediction of para-aortic lymph node metastasis in endometrioid adenocarcinoma of endometrium

The aim of this study was to assess factors associated with para-aortic lymph node metastasis in endometrioid adenocarcinoma. The data of 157 patients with endometrioid adenocancer, who underwent staging surgery, was reviewed retrospectively. A total of 23 patients (14.6%) had pelvic and 19 patients (12.1%) had para-aortic lymph node metastasis; 21% (4/19) of the patients with para-aortic lymph node involvement did not have pelvic lymph node metastasis. Para-aortic lymph node involvement was significantly more common in the presence of LVSI and pelvic lymph node metastasis, and pelvic lymph node metastasis was the only independent risk factor for para-aortic lymph node involvement. The sensitivity and NPV of positive pelvic lymph node in the prediction of para-aortic lymph node metastasis were found to be 78.9% and 97%, respectively. The corresponding rates for obturator and/or external iliac lymph node were 63.1% and 95%, respectively. In conclusion, although pelvic lymph node metastasis is the only independent risk factor for para-aortic lymph node involvement, negative pelvic lymph node is not enough to omit para-aortic lymph node dissection. On the other hand, intraoperative frozen section examination of obturator and/or external iliac lymph node to omit para-aortic lymphadenectomy might be a good option for the patients who have high medical risks for surgery.