Efficacy of Postoperative Para-Aortic and Pelvic Lymphadenectomies for Intermediate- to High-Risk Endometrial Cancer

A two-stage surgery for endometrial cancer is associated with a high physical and psychological burden on the patient and possibly increases the risk of subsequent abdominal surgeries. In this study, we aimed to characterize the oncological features of endometrial cancer patients with lymph node-positive and lymph node-recurrent disease who underwent two-stage lymphadenectomy after initial hysterectomy without pelvic and para-aortic lymphadenectomy and were at intermediate or high risk for postoperative recurrence.

This single-center retrospective study evaluated a total of 37 patients with endometrial cancer who underwent postoperative para-aortic lymphadenectomy between April 2020 and March 2023.

The median follow-up duration was 42 months. The 3-year survival rate was 90%, and the 3-year recurrence-free survival rate was 80%. Lymph node metastasis occurred in 13.5% of the patients, of whom 2.7% had skip metastases in the para-aortic lymph nodes only. Histologically, most patients (80%) had endometrioid carcinoma grade 1. Overall recurrence was observed in 16.2%. The median recurrence-free survival time was 20.5 months. Poorly differentiated or non-endometrioid histology was found in 66.6% of the patients. All patients with low-grade endometrioid carcinoma with lymph node metastasis or recurrence had p53 mutations.

No patients with lymph node metastasis relapsed during the follow-up period. Two-stage lymphadenectomy may have contributed to the favorable outcomes. However, it is difficult to perform molecular pathological evaluation in all cases preoperatively. Therefore, it is acceptable to perform a hysterectomy and undergo a two-stage lymphadenectomy in minimally invasive surgery according to risk classification.