Annals of Surgical Oncology

, Volume 21, Issue 8, pp 2755–2761 | Cite as

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

  • Tetsuji Odagiri
  • Hidemichi Watari
  • Tatsuya Kato
  • Takashi Mitamura
  • Masayoshi Hosaka
  • Satoko Sudo
  • Mahito Takeda
  • Noriko Kobayashi
  • Peixin Dong
  • Yukiharu Todo
  • Masataka Kudo
  • Noriaki Sakuragi
Gynecologic Oncology



The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.


A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.


Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.


Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer.


Lymph Node Metastatis Sentinel Node Endometrial Cancer Renal Vein Inferior Mesenteric Artery 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



We declare no conflict of interest for this study.

Supplementary material

10434_2014_3663_MOESM1_ESM.tif (60 kb)
Fig. S1 Prevalence of LNM sites in five categories in surgically-stagedendometrial cancer (TIFF 60 kb)
10434_2014_3663_MOESM2_ESM.tif (92 kb)
Fig. S2 Single site LNM in surgically-staged endometrial cancer (TIFF 92 kb)


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Copyright information

© Society of Surgical Oncology 2014

Authors and Affiliations

  • Tetsuji Odagiri
    • 1
  • Hidemichi Watari
    • 1
  • Tatsuya Kato
    • 1
  • Takashi Mitamura
    • 1
  • Masayoshi Hosaka
    • 1
  • Satoko Sudo
    • 1
  • Mahito Takeda
    • 1
  • Noriko Kobayashi
    • 1
  • Peixin Dong
    • 1
  • Yukiharu Todo
    • 2
  • Masataka Kudo
    • 1
  • Noriaki Sakuragi
    • 1
  1. 1.Department of Obstetrics and GynecologyHokkaido University Graduate School of MedicineSapporoJapan
  2. 2.Division of Gynecologic OncologyNational Hospital OrganizationSapporoJapan

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