title: The incidence of isolated para-aortic nodal metastasis in completely staged endometrial cancer patients.
abstract: OBJECTIVE
  To describe and review the incidence of para-aortic (PA) nodal metastasis in completely staged endometrial cancer patients who are negative for pelvic nodal metastasis.
  
  
  METHODS
  Using an institutionally maintained database, we identified all patients with endometrial cancer from 2002 to 2006 who had both pelvic and aortic nodal dissections and determined the rate of isolated para-aortic nodal metastasis in non-malignant (i.e. negative) pelvic nodes.
  
  
  RESULTS
  201 endometrial cancer patients were surgically treated at our institution from 2002 to 2006. 171 patients had both pelvic and PA nodes removed during surgery, and specimens examined by a pathologist. Only 2 (1.2%) had PA nodes that tested positive for malignance (i.e. positive PA nodes) with pelvic nodes that tested negative for malignance (i.e. negative pelvic nodes). The final International Federation of Gynecology and Obstetrics (FIGO) grade for the endometrial tumor cells in the two patients was "G1" with endometrioid adenocarcinoma and "G3" with endometrioid adenocarcinoma and mucinous differentiation, respectively.
  
  
  CONCLUSIONS
  Based on the very low incidence of patients inflicted with endometrial cancer that have positive para-aortic lymph nodes (PALNs) with negative pelvic nodes found both in our literature review (1.5%) and in our own study (1.2%), the addition of PA lymphadenectomy in all patients was found to have minimal diagnostic and therapeutic value. At the present, the role of complete PA lymphadenectomy in all patients with endometrial cancer should be re-examined. Individualized algorithms should be developed based on risk factors and status of pelvic nodes.
authors.affiliation: Department of Obstetrics and Gynecology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan, ROC.
authors.forename: An-Jen
authors.initials: AJ
authors.lastname: Chiang
authors.forename: Ken-Jen
authors.initials: KJ
authors.lastname: Yu
authors.forename: Kuan-Chong
authors.initials: KC
authors.lastname: Chao
authors.forename: Nelson N H
authors.initials: NN
authors.lastname: Teng
mesh_terms: D001013:Aorta, Thoracic; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D015994:Incidence; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis; D012189:Retrospective Studies