Abstract
The role of lymphadenectomy in endometrial cancer continues to provoke debate. The Mayo School advocates its use for the appropriate classification and treatment of those at risk of recurrent disease. The Manchester School argues that its use cannot be justified without clear evidence for a survival benefit. In this chapter, both sides of the debate are presented alongside a mutually agreeable trial design that has the potential to provide conclusive evidence, once and for all, for how early-stage endometrial cancer should be managed.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Siegel R, Naishadham D, Jemal A. Cancer statistics 2012. CA Cancer J Clin. 2012;62:10–29.
Flegal KM, Carroll MD, Ogden CL, Curtin LR. Prevalence and trends in obesity among US adults, 1999–2008. JAMA. 2010;303(3):235.
Crosbie EJ, Zwahlen M, Kitchener HC, Egger M, Renehan AG. Body mass index, hormone replacement therapy, and endometrial cancer risk: a meta-analysis. Cancer Epidemiol Biomarkers Prev. 2010;19:3119–30.
American College of Obstetricians and Gynecologists. ACOG practice bulletin, clinical management guidelines for obstetrician-gynecologists, number 65. August 2005: management of endometrial cancer. Obstet Gynecol. 2005;106:413.
Creasman WT, Odicino F, Maisonneuve P, Beller U, Benedet JL, Heintz AP. Carcinoma of the corpus uteri. Int J Gynaecol Obstet. 2003;83 Suppl 1:79–118.
Gynecologic Oncology Group Surgical Procedures Manual. Revised Jan 2010. Philadelphia: Gynecologic Oncology Group; 2010.
Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109:11–8.
Creutzberg CL, van Putten WLJ, Koper PC, et al. Survival after relapse in patients with endometrial cancer: results from a randomized trial. Gynecol Oncol. 2003;89:201–9.
Straughn JM, Huh WK, Orr Jr JW, Kelly FJ, Roland PY, Gold MA. Stage IC adenocarcinoma of the endometrium: survival comparisons of surgically staged patients with and without adjuvant radiation therapy. Gynecol Oncol. 2003;89:295–300.
Creutzberg CL, van Putten WL, Warlam-Rodenhuis CC, van den Bergh AC, de Winter KA, Koper PC. Outcome of high-risk stage IC, grade 3, compared with stage I endometrial carcinoma patients: the Postoperative Radiation Therapy in Endometrial Carcinoma Trial. J Clin Oncol. 2004;22:1234–41.
Larson DM, Broste SK, Krawisz BR. Surgery without radiotherapy for primary treatment of endometrial cancer. Obstet Gynecol. 1998;91:355–9.
Kitchener H, ASTEC Writing Committee. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373:125–36.
Benedetti Panici P, Basile S, Maneschi F. Systematic pelvic lymphadenectomy versus no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100:1707–16.
Goudge C, Bernhard S, Cloven NG, Morris P. The impact of complete surgical staging on adjuvant treatment decisions in endometrial cancer. Gynecol Oncol. 2004;93(2):536–9.
Case AS, Rocconi RP, Straughn Jr JM, Conner M, Novak L, Wang W, Huh WK. A prospective blinded evaluation of the accuracy of frozen section for the surgical management of endometrial cancer. Obstet Gynecol. 2006;108(6):1375–9.
Todo Y, Sakuragi N, Nishida R, Yamada T, Ebina Y, Yamamoto R, Fujimoto S. Combined use of magnetic resonance imaging, CA 125 assay, histologic type, and histologic grade in the prediction of lymph node metastasis in endometrial carcinoma. Am J Obstet Gynecol. 2003;188(5):1265–72.
Mariani A, Webb MJ, Galli L. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol Oncol. 2000;76:348–56.
Kumar S, Medeiros F, Dowdy SC, Keeney GL, Bakkum-Gamez JN, Podratz KC, et al. A prospective assessment of the reliability of frozen section to direct intraoperative decision making in endometrial cancer. Gynecol Oncol. 2012;127(3):525–31.
Alhilli MM, Podratz KC, Dowdy SC, Bakkum-Gamez JN, Weaver AL, McGree ME, et al. Preoperative biopsy and intraoperative tumor diameter predict lymph node dissemination in endometrial cancer. Gynecol Oncol. 2013;128(2):294–9.
Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60 Suppl 8:2035–41.
Boran N, Akdag D, Halici F, Tulunay G, Turan T, Bozok S, Erdogan Z, Kose MF. A retrospective analysis of the diameter of metastatic lymph nodes in apparently early stage endometrial cancer. Tumori. 2008;94(5):681–5.
Girardi F, Petru E, Heydarfadai M, Haas J, Winter R. Pelvic lymphadenectomy in the surgical treatment of endometrial cancer. Gynecol Oncology. 1993;49(2):177–80.
Kwon JS, Mazgani M, Miller DM, Ehlen T, et al. The significance of surgical staging in intermediate-risk endometrial cancer. Gynecol Oncol. 2011;122(1):50–4.
McMeekin DS, Lashbrook D, Gold M, Johnson G, Walker JL, Mannel R. Analysis of FIGO Stage IIIc endometrial cancer patients. Gynecol Oncol. 2001;81:273–8.
Todo Y, Kato H, Kaneuchi M, et al. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375:1165.
Konno Y, Todo Y, Minobe S, Kato H, Okamoto K, Sudo S, et al. A retrospective analysis of postoperative complications with or without para-aortic lymphadenectomy in endometrial cancer. Int J Gynecol Cancer. 2011;21(2):385–90.
Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC. Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol. 2000;182:1506–19.
Mariani A, Dowdy SC, Cliby WA, Haddock MG, Keeney GL, Lesnick TG. Efficacy of systematic lymphadenectomy and adjuvant radiotherapy in node-positive endometrial cancer patients. Gynecol Oncol. 2006;101:200–8.
Watari H, Mitamura T, Moriwaki M, Hosaka M, Ohba Y, Sudo S, Todo Y, Takeda M, Ebina Y, Sakuragi N. Survival and failure pattern of patients with endometrial cancer after extensive surgery including systematic pelvic and para-aortic lymphadenectomy followed by adjuvant chemotherapy. Int J Gynecol Cancer. 2009;19(9):1585–90.
Onda T, Yoshikawa H, Mizutani K. Treatment of node-positive endometrial cancer with complete node dissection, chemotherapy and radiation therapy. Br J Cancer. 1997;75:1836–41.
Kong A, Johnson N, Kitchener HC, Lawrie TA. Adjuvant radiotherapy for stage I endometrial cancer: an updated Cochrane systematic review and meta-analysis. J Natl Cancer Inst. 2012;104(21):1625–34.
Creutzberg CL, van Putten WL, Koper PC, Lybeert ML, Jobsen JJ, Warlam-Rodenhuis CC. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomized trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carcinoma. Lancet. 2000;355:1404–11.
Mariani A, Dowdy S, Podratz KC. The role of pelvic and para-aortic lymph node dissection in the surgical treatment of endometrial cancer: a view from the USA. Obstetrician Gynaecologist. 2009;11(3):199–204.
Chan JK, Cheung MK, Huh WK, Osann K, Husain A, Teng NN, Kapp DS. Therapeutic role of lymph node resection in endometrial corpus cancer. Cancer. 2006;107(8):1823–30.
Smith DC, MacDonald OK, Lee CM, Gaffney DK. Survival impact of lymph node dissection in endometrial adenocarcinoma: as surveillance, epidemiology, and end results analysis. Int J Gynecol Cancer. 2008;18:255–61.
Ballester M, Dubernard G, Lécuru F, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Rouzier R, Daraï E. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12:469–76.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2014 Springer-Verlag London
About this chapter
Cite this chapter
Kitchener, H.C., Butler, K.A., Crosbie, E.J., Mariani, A. (2014). Lymphadenectomy in Endometrial Cancer: The Controversy Rages Unabated. In: Ledermann, J., Creutzberg, C., Quinn, M. (eds) Controversies in the Management of Gynecological Cancers. Springer, London. https://doi.org/10.1007/978-0-85729-910-9_4
Download citation
DOI: https://doi.org/10.1007/978-0-85729-910-9_4
Published:
Publisher Name: Springer, London
Print ISBN: 978-0-85729-909-3
Online ISBN: 978-0-85729-910-9
eBook Packages: MedicineMedicine (R0)