title: Initial failure site according to primary treatment with or without para-aortic lymphadenectomy in endometrial cancer.
abstract: OBJECTIVE
  The objective of this study was to compare the initial failure sites in patients with endometrial cancer who underwent surgical treatment including pelvic lymphadenectomy with or without para-aortic lymphadenectomy.
  
  
  METHODS
  A retrospective chart review was carried out for 657 endometrial cancer patients with no residual disease after initial treatments including lymphadenectomy at two tertiary centers between 1987 and 2004. Surgical treatment at one institute included pelvic lymphadenectomy (PLX) without para-aortic lymphadenectomy (PALX), while surgical treatment including PLX+PALX was routinely performed at the other institute. We identified patients with recurrence and evaluated initial failure sites. Rates of recurrence in the respective sites were compared according to the type of lymphadenectomy.
  
  
  RESULTS
  Of the 657 patients, 103 (15.7%) suffered recurrence. There was no significant difference between the rate of intrapelvic recurrence in the PLX alone group and that in the PLX+PALX group (4.7% vs. 2.9%, p=0.22). The rate of extrapelvic recurrence in the PLX alone group was significantly higher than that in the PLX+PALX group (16.1% vs. 6.2%, p<0.0001), and the rate of para-aortic node (PAN) recurrence in the PLX alone group was also significantly higher than that in the PLX+PALX group (5.1% vs. 0.6%, p=0.0004). In the analysis of patients who received adjuvant chemotherapy, the rate of PAN recurrence in the PLX alone group was significantly higher than that in the PLX+PALX group (9.5% vs. 1.3%, p=0.0036).
  
  
  CONCLUSIONS
  PAN recurrence was a failure pattern peculiar to the PLX alone group. Adjuvant chemotherapy might not be able to replace surgical removal as a treatment for metastatic lymph nodes.
authors.affiliation: Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan. yukiharu@sap-cc.go.jp
authors.forename: Yukiharu
authors.initials: Y
authors.lastname: Todo
authors.forename: Hidenori
authors.initials: H
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Minobe
authors.forename: Kazuhira
authors.initials: K
authors.lastname: Okamoto
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Suzuki
authors.forename: Satoko
authors.initials: S
authors.lastname: Sudo
authors.forename: Mahito
authors.initials: M
authors.lastname: Takeda
authors.forename: Hidemichi
authors.initials: H
authors.lastname: Watari
authors.forename: Masanori
authors.initials: M
authors.lastname: Kaneuchi
authors.forename: Noriaki
authors.initials: N
authors.lastname: Sakuragi
mesh_terms: D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D012189:Retrospective Studies