Lymphadenectomy for low-risk endometrial cancer based on preoperative and intraoperative assessments.
BACKGROUND
The aim of this study was to ascertain whether lymphadenectomy is necessary when endometrial cancer is considered low risk based on preoperative and intraoperative assessments.


METHODS
Between 2000 and 2004, a total of 122 patients with low-risk endometrial cancer who underwent preoperative endometrial sampling and magnetic resonance imaging (MRI) were treated surgically. All 122 patients were considered eligible for the study if they fulfilled the following criteria: (a) grade 1 or 2 endometrioid corpus cancer by endometrial sampling, (b) no lymphadenopathy by MRI, (c) myometrial invasion of 50% or less by MRI, and (d) no intraoperative evidence of macroscopic extrauterine spread. We divided the 122 patients into 2 groups (the total abdominal hysterectomy and bilateral salpingo-oophorectomy [TH/bilateral salpingo-oophorectomy] with lymphadenectomy [THND group, n = 64] and the TH/bilateral salpingo-oophorectomy without lymphadenectomy [TH group, n = 58]).


RESULTS
The concordance rate between preoperative and postoperative grades was 92.6% (113/122, kappa = 0.805). Evaluation of the depth of myometrial invasion with MRI had an accuracy of 95.1% (116/122) for ruling out deep myometrial invasion. In the THND group, the operative time, the hospital stay, the estimated blood loss during surgery, and the incidence of perioperative complications were significantly higher than those in the TH group. The 5-year progression-free survival rates were similar (96.9% in the THND group and 98.3% in the TH group).


CONCLUSIONS
The present findings suggest that MRI and office endometrial sampling may accurately categorize patients into low- or high-risk groups. Lymphadenectomy should be limited to patients with high-risk endometrial cancer.
Kang
Woo Dae
WD
Department of Obstetrics and Gynecology, Chonnam National University Medical School, Gwangju, Republic of Korea.
Kim
Cheol Hong
CH
Cho
Moon Kyoung
MK
Kim
Jong Woon
JW
Kim
Yoon Ha
YH
Choi
Ho Sun
HS
Kim
Seok Mo
SM
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D007432:Intraoperative Period; D008197:Lymph Node Excision; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D009215:Myometrium / Q000473:pathology; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010052:Ovariectomy; D011300:Preoperative Care; D012189:Retrospective Studies; D012307:Risk Factors