Long-Term Outcomes of Therapeutic Pelvic Lymphadenectomy for Stage I Endometrial Adenocarcinoma* 1 (original) (raw)
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International Journal of Gynecological Cancer, 2006
Two hundred and eight patients with a clinical stage I endometrial carcinoma were studied (164 fulfilled the inclusion criteria). High risk was defined as nonendometrioid, or endometrioid tumors grade 3 (G3), or G2 with any or G1 with deep (.1/2) myometrial infiltration. The low-risk group consisted of the remaining patients. Surgical staging in the high-risk group included pelvic lymphadenectomy with para-aortic lymphadenectomy in selected cases. Twelve percent of the high-risk patients had nodal metastasis. Patients with low-risk (group A, n ¼ 85) and high-risk disease confined to the uterus (group B, n ¼ 57) did not receive adjuvant radiotherapy. Patients with nodal metastases (group C, n ¼ 10) received postoperative irradiation. The total recurrence rate of the entire population was 12.5%, and the actuarial overall survival, disease-specific survival, and disease-free survival were 90%, 94%, and 88%, respectively. All patients with only vaginal relapse (n ¼ 9) were cured locally with salvage radiotherapy until the date of analysis. The pelvic relapse rate was low as only one patient of group B recurred in the pelvis. In conclusion, lymphadenectomy remains indicated to better select patients at high risk of pelvic recurrence that may benefit from postoperative radiotherapy.
Routine pelvic lymphadenectomy in apparently early stage endometrial cancer
European Journal of Surgical Oncology (EJSO), 2006
Aims: Controversial issues with respect to the treatment of patients with endometrial cancer include indications for lymphadenectomy and adjuvant radiotherapy. Patient and methods: Between 1998 and 2004 all women with endometrial cancer stage I were included (nZ335). They all underwent total abdominal hysterectomy and bilateral salpingo-oöphorectomy. Two hundred and thirty-seven women also had a pelvic lymphadenectomy. When pelvic lymphadenectomy was performed, radiotherapy was administered only to patients with lymph-node metastases. Otherwise, adjuvant radiotherapy was based on the presence of risk factors. Results: Eleven patients had lymph-node metastases. The overall absolute and relative survival-estimate at 5 years was 85.0 and 93.7%, respectively. Loco-regional recurrence was 8.5%. In the group with pelvic lymphadenectomy and negative lymph nodes these rates were 88.2, 93.9 and 5.6%, respectively. In 58 patients without any of the risk factors tumour grade III, deep myometrial invasion, or age R60 years, no lymph-node metastases were found. Conclusion: In patients with endometrial cancer FIGO stage I without risk-factors, a phenomenon which occurs in about 25% of patients with clinical stage I endometrial cancer, a lymphadenectomy can be omitted. In other patients, the debate regarding the optimal treatment will remain.
Archives of Gynecology and Obstetrics, 2006
The purpose of the study is to evaluate whether surgery followed by radiotherapy in highrisk patients of early stage endometrial cancer can be replaced by formal surgical staging. Cancer-related survival and recurrence-free survival (RFS) were the endpoints of the analysis. Study design: One hundred and eighteen patients with endometrioid endometrial adenocarcinoma between 1996-2003 were reviewed. Patients with incomplete follow-up and extrauterine spread excluded, leaving 78 women in the final analysis. Low-risk patients (n=37) (Grade 1, myometrial infiltration <1/2 or Grade2, <1/3), treated by standard surgical procedure including total abdominal hysterectomy, bilateral salpingo-oophorectomy and peritoneal washing, while staging lymphadenectomy (n=24) or postoperative irradiation (n=17) was added in the highrisk group (Grade 1, >1/2 or Grade 2, >1/3 or Grade3). Results: The median age of patients was 65 years (range, 35-80 years) and the median follow-up 38 months (range, 9-98 months). The recurrence rate in low-risk patients was 2.7%, the cancer-related survival 97.5% and RFS 97%, while in the high-risk patients 12%, 93% and 88%, respectively. Comparing the therapeutic modalities (staging lymphadenectomy vs. postoperative irradiation) in the high-risk group the cancerrelated survival and RFS was not differed (P=0.70, P=0.90, respectively). The high grade of the tumor was significantly correlated with RFS, while age, stage and myometrial infiltration were not. No moderate or severe complications developed after lymphadenectomy, while two moderate gastrointestinal complications occurred after adjuvant radiotherapy. Conclusion: According our results the low-risk patients of early stage endometrial adenocarcinoma had excellent survival with minimal intervention. The cancer-related survival and RFS in high-risk patients concerning the therapeutic modalities were comparable. Poor tumor differentiation was the most unfavorable prognostic factor related with RFS. Moderate complications developed only after postoperative radiotherapy.
Role of Pelvic Lymphadenectomy in Cases of Grade 1 Endometrial Cancer
al-azhar medical journal, 2021
Background: Endometrial cancer (EC) is the most common malignancy of the female reproductive tract. Most patients are diagnosed with an early-stage disease, and the overall survival for stage I in about 85–91%. Objective: To assess the role of pelvic lymphadenectomy in management of early stage endometrial carcinoma in order to determine whether the patient is in need to postoperative radiotherapy or not. Patients and Methods: This was a prospective observational study included 52 postmenopausal patient who complained from vaginal bleeding and underwent endometrial biopsy revealing the presence of endometrial hyperplasia with atypia or grade 1 endometrial adenocarcinoma attended the Gynecological clinic at Maadi Military Hospital Cairo, Egypt from March 2018 to February 2020. Results: Myometrial invasion in MRI ¬¬and histopathology was 73.1% and 65.4% respectively, with no statistically significant difference. Parametrial invasion was 7.7% and 9.6% respectively with no statistically...
Anticancer research
The role of pelvic lymphadenectomy in early endometrial carcinoma is still being debated. We retrospectively analyzed a total of 131 patients with FIGO stage I endometrial cancer undergoing surgery without (Group 1) or with (Group 2) pelvic lymphadenectomy. Kaplan-Meier and Cox analyses were used to calculate crude and adjusted survival rates. Moreover, the overlap of pre- and post-surgical staging was analyzed. Overall survival rate at 5 years was 90.1%. The difference in crude survival rates of the two groups is not statistically significant (p-value= 0.3777, log rank test). Five patients of Group 2 presented positive pelvic nodes. Therefore our results showed a pre-surgical understaging, referring to nodal involvement, in 9.1% of cases (5/55). Pelvic lymphadenectomy is a useful procedure for prognostic and staging purposes, but does not improve survival in FIGO stage I endometrial carcinoma.
Most adenocarcinomas of the uterine corpus remain confined to the organ of origin. Some will metastasize. 1 Many cancer surgeons have performed and continue to perform pelvic and periaortic lymphadenectomy in addition to hysterectomy to detect those metastases with the expectation that the findings will inform further therapy. 2 If no lymphatic metastases are found, the patient may be spared toxic adjuvant therapy. If lymphatic metastases are identified by lymphadenectomy, then tumor-directed therapy is often successful. 3 If lymphatic metastases are not detected and lymphatic recurrence develops , successful treatment is only occasionally achieved. 1 Some have questioned the necessity of lymphadenectomy; they presumably believe that ignorance of lymphatic metastasis does not compromise patient outcomes. 4 Compelling data show that lymphadenectomy is diagnostic and therapeutic. The Gynecologic Oncology Group (GOG) reported the surgicopathological features of 621 patients with carcinoma of the endometrium that preoperatively appeared to be confined to the uterus. In protocol 33, all patients were treated with primary surgery, which consisted of total abdominal hysterectomy, bilateral salpingo-oophorectomy, selective pelvic and para-aortic lymphadenectomy, and peritoneal cytology. Extrauterine metastases were found in 22% (lymph nodes, adnexa, intraperitoneal, and/or malignant cells in peritoneal washings). In half of those (11%), the metastases were in the pelvic (9%) and/or periaortic (6%) lymph nodes. Fewer than 10% of those metastatic nodes were palpably enlarged. Without lymphadenectomy, 90% of the lymphatic metastases would have gone undetected. The risk of lymph node me-tastasis increased with the depth of myometrial invasion and the histologic grade. This allowed some grouping based on uterine factors and their associated risk of lymphatic metastases (Table 1). 5 Largely because of this study, the International Federation of Gynecology and Obstetrics accepted a surgically based staging system, including lymphadenectomy, for en-dometrial cancer in 1988. Since then, there has been debate about whether lymphadenectomy is merely diagnostic or also could be therapeutic. 4 Kilgore et al 6 reported on 649 patients who were surgically managed. Those undergoing multiple-site pelvic node sampling had significantly better survival than patients without node sampling (P 5 .0002). In a comparison of patients receiving whole pelvic radiation for grade 3 lesions or deep myometrial invasion, patients with multiple-site pelvic node sampling had better survival than those whose nodes were not sampled (P 5 .0027). Overall, those undergoing lymph node removal had better survival than those without lymph node removal who then received postoperative radiation. Cra-gun et al 7 reported that patients with poorly differentiated cancers with 11 or more lymph nodes removed had improved survival (hazard ratio, 0.25) and progression-free survival (hazard ratio, 0.26) in comparison with those with fewer than 11 lymph nodes removed. However, the number of lymph nodes removed was not predictive of survival outcomes among those with grade 1 and 2 tumors. This association between lymphadenectomy and improved survival remained when they controlled for adjuvant radiation. This reinforced the impact of selective lymphadenectomy. A review of Surveillance, Epidemiology , and End Results data for 12,333 women was published by Chan et al. 8 Among the intermediate/high-risk patients (stage IB/grade 3 and stages IC-IV/all grades), more extensive lymph node resection (1, 2-5, 6-10, 11-20, and >20 nodes) was associated with improved 5-year disease-specific survival across all 5 groups (75%, 82%, 84%, 85%, and 87%, respectively; P < .001). For stage IIIC-IV patients with nodal metastases, the extent of node resection significantly improved the survival rate from 51% to 53% to 53% to 60% to 72% (P < .001). However, there was no benefit of nodal
2015
Background Pelvic lymph nodes are the most common site of extrauterine tumor spread in early-stage endometrial can-cer, but the clinical impact of lymphadenectomy has not been addressed in randomized studies. We con-ducted a randomized clinical trial to determine whether the addition of pelvic systematic lymphadenectomy to standard hysterectomy with bilateral salpingo-oophorectomy improves overall and disease-free survival. Methods From October 1, 1996, through March 31, 2006, 514 eligible patients with preoperative International Federation of Gynecology and Obstetrics stage I endometrial carcinoma were randomly assigned to undergo pelvic systematic lymphadenectomy (n = 264) or no lymphadenectomy (n = 250). Patients ’ clinical