Abstract
We aimed to evaluate para-aortic metastases relative to the level of inferior mesenteric artery (IMA) and to discuss the clinico-pathological features of these patients. A total of 204 patients who underwent systematic pelvic and para-aortic lymphadenectomy up to the level of renal veins for endometrial cancer between January 2007 and August 2013 were included in this study. Of these 204 patients, 44 (21.6 %) had lymph node involvement. From a total of 27 patients with paraaortic lymph node (PALN) metastasis, 11 had only supramesenteric and 4 had only inframesenteric nodal involvement, while 12 had both supramesenteric and inframesenteric metastases. Supramesenteric lymph node metastases were detected in 85.2 % of patients who have para-aortic metastases and in 11.3 % of all patients. Additionally, 5 patients had only supramesenteric lymphatic metastasis. The surgico-pathological characteristics of patients with isolated supramesenteric and inframesenteric metastasis were similar. However, the patients with lymphatic spread in both regions were found to have pelvic lymphatic metastasis and cervical invasion more commonly compared to patients with only supramesenteric or only inframesenteric metastasis. The site of metastatic lymph nodes wasn’t associated with the likelihood and site of recurrence. Lymphadenectomy should be performed up to the level of renal vein in case of the presence of indication for lymphadenectomy in patients with endometrial cancer. Additionally, it is not possible to predict the patients with supramesenteric lymph node involvement by tumor grade, histological type and myometrial invasion.
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References
Announcements (1989) FIGO (the International Federation of Obstetricians and Gynecologists) stages: 1988 revision. Gynecol Oncol 35:125–126
Hoekstra AV, Kim RJ, Small W Jr et al (2009) FIGO stage IIIC endometrial carcinoma: prognostic factors and outcomes. Gynecol Oncol 114(2):273–278
McMeekin DS, Lashbrook D, Gold M, Johnson G, Walker JL, Mannel R (2001) Analysis of FIGO Stage IIIC endometrial cancer patients. Gynecol Oncol 81(2):273–278
Creasman WT, Morrow CP, Bundy BN et al (1987) Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group study. Cancer 60:2035–2041
Hirahatake K, Hareyama H, Sakuragi N et al (1997) A clinical and pathologic study on para-aortic lymph node metastasis in endometrial carcinoma. J Surg Oncol 65:82–87
Mariani A, Keeney GL, Aletti G et al (2004) Endometrial carcinoma: paraaortic dissemination. Gynecol Oncol 92:833–838
Turan T, Hizli D, Sarici S et al (2011) Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? Eur J Obstet Gynecol Reprod Biol 158(2):274–279
National Comprehensive Cancer Network (2006) Clinical practice guidelines in oncology, uterine cancers. Version 1. National Comprehensive Cancer Network, Washington, DC
ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomized study. Lancet 373(9658):125–136
Chan JK, Cheung MK, Huh WK et al (2006) Therapeutic role of lymph node resection in endometrioid corpus cancer: a study of 12,333 patients. Cancer 107(8):1823–1830
Fotopoulou C, Savvatis K, Kraetschell R, Schefold JC, Lichtenegger W, Sehouli J (2010) Systematic pelvic and aortic lymphadenectomy in intermediate and high-risk endometrial cancer: lymph-node mapping and identification of predictive factors for lymph-node status. Eur J Obstet Gynecol Reprod Biol 149(2):199–203
Kumar S, Podratz KC, Bakkum-Gamez JN et al (2014) Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol Oncol 132(1):38–43
Nomura H, Aoki D, Suzuki N et al (2006) Analysis of clinicopathologic factors predicting para-aortic lymph node metastasis in endometrial cancer. Int J Gynecol Cancer 16(2):799–804
Odagiri T, Watari H, Kato T, et al (2014) Distribution of lymph node metastasis sites in endometrial cancer undergoing systematic pelvic and para-aortic lymphadenectomy: a proposal of optimal lymphadenectomy for future clinical trials. Ann Surg Oncol
Chang SJ, Kim WY, Yoon JH, Yoo SC, Chang KH, Ryu HS (2008) Para-aortic lymphadenectomy improves survival in patients with intermediate to high-risk endometrial carcinoma. Acta Obstet Gynecol Scand 87(12):1361–1369
Mariani A, Webb MJ, Galli L, Podratz KC (2000) Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol Oncol 76(3):348–356
Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375(9721):1165–1172
Meeting Report (2009) The new FIGO staging system for cancers of the vulva, cervix, endometrium and sarcomas. Gynecol Oncol 115:325–328
Turan T, Yilmaz SS, Hizli D et al (2011) A prospective evaluation of lymphatic dissemination in endometrial cancer: is it adequate to perform lymph node dissection up to the inferior mesenteric artery? Int J Gynecol Cancer 21(5):864–869
Creutzberg CL, van Putten WL, Koper PC et al (2000) 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 355(9213):1404–1411
National Comprehensive Cancer Network (2014) Clinical practice guidelines in oncology, uterine cancers. Version 1. National Comprehensive Cancer Network, Washington, DC
Yokoyama Y, Maruyama H, Sato S et al (1997) Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol 64:411–417
Mariani A, Dowdy SC, Cliby WA et al (2008) Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 109:11–18
Burke TW, Levenback C, Tornos C et al (1996) Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol 62:169–173
Maccauro M, Lucignani G, Aliberti G et al (2005) Sentinel lymph node detection following the hysteroscopic peritumoural injection of 99mTc-labelled albumin nanocolloid in endometrial cancer. Eur J Nucl Med Mol Imaging 32:569–574
Turan T, Hizli D, Sarici S et al (2012) What is the impact of cervical invasion on lymph node metastasis in patients with stage IIIC endometrial cancer? Arch Gynecol Obstet 285(4):1119–1124
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Alay, I., Turan, T., Ureyen, I. et al. Lymphadenectomy Should Be Performed Up to the Renal Vein in Patients with Intermediate-High Risk Endometrial Cancer. Pathol. Oncol. Res. 21, 803–810 (2015). https://doi.org/10.1007/s12253-014-9893-4
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DOI: https://doi.org/10.1007/s12253-014-9893-4