ARTICLE Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial (original) (raw)
Related papers
Journal of Gynecologic Surgery, 2010
Objective: Pelvic lymph nodes are the most common site of extrauterine spread in clinical early-stage endometrial cancer. International Federation of Gynecology and Obstetrics has mandated surgical evaluation of lymph nodes in endometrial cancer since 1988; however, the clinical impact of lymphadenectomy has never been addressed. Design: We reported a retrospective analysis in order to evaluate whether pelvic systematic lymph dissection improves overall and progression-free survival compared with no lymphadenectomy. Method: From 1991 through 2008, patients with endometrial carcinoma were evaluated using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. Results: Of the 410 patients with a diagnosis of endometrial carcinoma, 390 underwent primary surgery. Of those who underwent surgery, 285 had endometrioid histology. One hundred and ninety (190) patients had surgery with no lymphadenectomy, whereas 95 had surgery with lymphadenectomy. Only 4 women revealed positive nodes. Median number of removed nodes was 14 in the lymphadenectomy group. The 5-year survival rate of 90% and 86% was achieved, respectively, for lymphadenectomy and no lymphadenectomy (p ¼ 0.501). Conclusions: Although systematic pelvic lymphadenectomy significantly improved surgical staging of women with clinical early-stage endometrial carcinoma by detecting a higher rate of patients with positive nodes, it did not improve overall survival.
Lymphadenectomy for the management of endometrial cancer
2009
Background This is an update of a previous Cochrane review published in Issue 1, 2010 and updated in Issue 9, 2015. The role of lymphadenectomy in surgical management of endometrial cancer remains controversial. Lymph node metastases can be found in approximately 10% of women who before surgery are thought to have cancer confined to the womb. Removal of all pelvic and para-aortic lymph nodes (lymphadenectomy) at initial surgery has been widely advocated, and pelvic and para-aortic lymphadenectomy remains part of the FIGO (International Federation of Gynaecology and Obstetrics) staging system for endometrial cancer. This recommendation is based on data from studies that suggested improvement in survival following pelvic and para-aortic lymphadenectomy. However, these studies were not randomised controlled trials (RCTs), and treatment of pelvic lymph nodes may not confer a direct therapeutic benefit, other than allocating women to poorer prognosis groups. Furthermore, the Cochrane review and meta-analysis of RCTs of routine adjuvant radiotherapy to treat possible lymph node metastases in women with early-stage endometrial cancer found no survival advantage. Surgical removal of pelvic and para-aortic lymph nodes has serious potential short-term and long-term sequelae. Therefore, it is important to investigate the clinical value of this treatment. Objectives To evaluate the effectiveness and safety of lymphadenectomy for the management of endometrial cancer. Search methods We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and Embase to June 2009 for the original review, updated the search to June 2015 for the last updated version and further extended the search to March 2017 for this version of the review. We also searched registers of clinical trials, abstracts of scientific meetings, and reference lists of included studies, and we contacted experts in the field. Selection criteria RCTs and quasi-RCTs that compared lymphadenectomy versus no lymphadenectomy in adult women diagnosed with endometrial cancer. Lymphadenectomy for the management of endometrial cancer (Review)
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.
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.
International Journal of Gynecologic Cancer, 2014
ObjectiveThe aim of this study is to assess the impact of lymphadenectomy (LND) on morbidity, survival, and cost for high-risk histologic types of endometrial cancer (EC).Materials and MethodsWe analyzed a multicenter retrospective cohort of 389 women with high-risk histotypes of EC (poor differenced tumors [G3], clear cell, serous papillary, and mixed mesodermal tumors) preoperatively confined to the corpus and diagnosed between 2000 and 2013. All patients underwent hysterectomy and bilateral salpingo-oophorectomy. A matched-pair analysis identified 97 pairs (97 with LDN and 97 without) equal in age, body mass index, comorbidities, International Federation of Gynecology and Obstetrics stage, and adjuvant treatment. Demographic data, pathologic examination results, perioperative morbidity, and survival were abstracted from medical records. Cost was provided by the cost unit of the local hospital. Disease-free and overall survival were analyzed using the Kaplan-Meier curves and Cox m...
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...
The role of lymphadenectomy in patients with endometrial cancer
J Gynecol Women’s Health, 2016
Endometrial cancer (EC) represents the most common malignancy of the female genital tract in developed countries [1-10]. Current international guidelines (ACOG, FIGO, SGO, ESGO and ESMO), recommend systematic surgical staging as the initial treatment approach for all types of EC [type I (endometrioid) and type II (serous, clear cell, undifferentiated)] [2-4,6-15]. This is mainly because systematic surgical staging offers many diagnostic, prognostic and therapeutic benefits for these patients [2-4,6-13].