Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer

Patients with high-risk early or advanced endometrial cancer (EC) are at high risk for lymph node (LN) metastases. However, both the anatomical pattern of the LN metastases and also the therapeutic value of systematic LN dissection remain a field of discussion and controversy.

We performed an exploratory analysis of patients with high-risk or advanced EC who underwent systematic pelvic and para-aortic lymphadenectomy in two tertiary referral centers for gynecological malignancies.

One hundred and twenty-eight completely surgically staged patients underwent systematic pelvic and para-aortic lymphadenectomy for high-risk or advanced EC. A median of 29 and 21.5 LN was harvested in the pelvis and in the para-aortic region, respectively. Overall, 27 patients (21.1 %) had positive LN: 18 % showed positive pelvic LN and 14.8 % positive para-aortic LN; while 3.1 % showed isolated para-aortic LN metastases. Five-year overall survival was 70 versus 30 % in LN-negative versus LN-positive patients (p < 0.01). LN-status was the only factor significantly associated with overall survival [HR: 3.67 (95 % CI 1.48-9.11); p = 0.01] in a multivariate Cox regression model.

Patients with high-risk or advanced EC were at a high-risk for LN metastases. Anatomical distribution of positive LN indicates that lymphadenectomy, when performed, should contain both pelvic and para-aortic areas up to the renal vessels for an accurate assessment of all potential positive LN.