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

  • Gynecologic Oncology
  • Published:
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Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

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Conflict of interest

The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Department of Gynecology and Obstetrics, Charité Campus Virchow-Klinikum, Berlin, Germany

    Christina Fotopoulou, Jalid Sehouli, Mustafa Z. Muallem & Robert W. Krätschell

  2. Department of Gynecology, Imperial College London, London, UK

    Christina Fotopoulou

  3. Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany

    Ahmed El-Balat, Andreas du Bois, Philipp Harter, Mustafa Z. Muallem, Alexander Traut & Florian Heitz

  4. Department of Gynecology and Obstetrics, Goethe University of Frankfurt, Frankfurt, Germany

    Ahmed El-Balat

  5. Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany

    Andreas du Bois, Philipp Harter, Alexander Traut & Florian Heitz

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  1. Christina Fotopoulou
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Correspondence to Florian Heitz.

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Fotopoulou, C., El-Balat, A., du Bois, A. et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch Gynecol Obstet 292, 1321–1327 (2015). https://doi.org/10.1007/s00404-015-3746-6

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  • DOI: https://doi.org/10.1007/s00404-015-3746-6

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