Can we omit para-aorta lymph node dissection in endometrial cancer?
BACKGROUND
Patients with endometrial cancer can present with various complicating illnesses, including obesity, diabetes mellitus, hypertension and advanced aging. These patients are at high risk of severe post-operative complications. Thus, the question of whether or not to perform systemic pelvic and para-aortic lymphadenectomy remains controversial for all patients. It is reported that external iliac lymph nodes are the most commonly involved lymph nodes in endometrial cancer, and para-aortic lymph node (PAN) metastases spread via a route shared by the common iliac lymph nodes. The aim of this study was to evaluate the potential efficacy of omitting PAN dissection when metastasis of the common iliac and external iliac lymph nodes is negative.


METHODS
Between January 1994 and June 2004, a total of 101 patients at Akita University Hospital who had undergone total hysterectomy and bilateral salpingo-oophorectomy, total pelvic lymphadenectomy and para-aortic lymphadenectomy to the level of the renal vein for endometrial cancer were enrolled in this study.


RESULTS
Eleven patients in all were found to have metastasis for PANs. Among 13 patients with common and/or external iliac positive lymph nodes, 10 showed PAN metastasis. Of the 88 patients with negative lymph nodes, 87 showed no PAN metastasis. Based on these data, common and/or external iliac lymph nodes had 90.9% sensitivity (10/11) and 96.7% specificity (87/90) for detecting PAN metastasis.


CONCLUSIONS
Para-aortic lymphadenectomy might be avoided by the negativity of such lymph nodes, thereby minimizing post-operative complications.
Tanaka
Hidenori
H
Department of Obstetrics and Gynecology, Akita University School of Medicine, Akita-Ken, 010-8543, Japan. tanakah@obgyn.med.akita-u.ac.jp
Sato
Hirokazu
H
Miura
Hiroshi
H
Sato
Naoki
N
Fujimoto
Toshio
T
Konishi
Yoshitomo
Y
Takahashi
Osamu
O
Tanaka
Toshinobu
T
D018262:Adenocarcinoma, Clear Cell / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001011:Aorta; D018269:Carcinoma, Endometrioid / Q000473:pathology / Q000601:surgery*; D000075202:Contraindications; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007083:Iliac Artery; D008197:Lymph Node Excision / Q000379:methods*; D008198:Lymph Nodes / Q000473:pathology*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010388:Pelvis; D011183:Postoperative Complications / Q000517:prevention & control; D012680:Sensitivity and Specificity