title: A prospective evaluation of lymphatic dissemination in endometrial cancer: is it adequate to perform lymph node dissection up to the inferior mesenteric artery?
abstract: OBJECTIVE
  This study aimed to assess para-aortic metastases relative to the inferior mesenteric artery (IMA). In addition, the clinicopathologic features of these patients are discussed.
  
  
  METHODS
  Between 2007 and 2009, a total of 78 consecutive patients who had open systematic pelvic and para-aortic lymphadenectomy surgery for endometrial cancer extending to the renal vessels and who were treated at the gynecologic oncology department were included in this prospective study. The para-aortic lymph nodes (PALNs) removed from these patients were classified as supramesenteric (between the renal vein and the IMA) or inframesenteric (between the IMA and the presacral). Patients' clinical data, pathologic tumor characteristics, and operative and early postoperative data were recorded after surgery. Descriptive statistics were calculated using the SPSS 17.0 package program.
  
  
  RESULTS
  Of these 78 patients, 18 (21.3%) had metastatic nodal involvement. From a total of 12 patients with PALN metastasis, 7 had only supramesenteric and 1 had only inframesenteric nodal involvement, whereas 4 had both supramesenteric and inframesenteric metastases. Of the 5 patients in the inframesenteric±supramesenteric group, none had a grade 1 tumor. On the other hand, of the 7 patients with only supramesenteric metastasis, 57.1% (n=4) had a grade 1 tumor and 42.8% (n=3) had less than half of myometrial invasion.
  
  
  CONCLUSIONS
  In the case of well-defined risk factors in which a lymphadenectomy is indicated according to current guidelines from the International Federation of Gynecology and Obstetrics, a PALN dissection should be extended up to the renal vessels. We also conclude that tumor grade, histologic type, and myometrial invasion cannot be used as markers to decide on supramesenteric lymphadenectomy in endometrial cancer.
authors.affiliation: Gynecologic Oncology, Zübeyde Hanım Women's Health Research and Teaching Hospital, Ankara, Turkey.
authors.forename: Taner
authors.initials: T
authors.lastname: Turan
authors.forename: Saynur Sarici
authors.initials: SS
authors.lastname: Yilmaz
authors.forename: Deniz
authors.initials: D
authors.lastname: Hizli
authors.forename: Burcu
authors.initials: B
authors.lastname: Gündoğdu
authors.forename: Nurettin
authors.initials: N
authors.lastname: Boran
authors.forename: Gökhan
authors.initials: G
authors.lastname: Tulunay
authors.forename: Ahmet
authors.initials: A
authors.lastname: Özfuttu
authors.forename: M Faruk
authors.initials: MF
authors.lastname: Köse
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D003949:Diagnostic Techniques, Surgical; D016889:Endometrial Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000706:statistics & numerical data*; D008207:Lymphatic Metastasis; D017537:Mesenteric Artery, Inferior / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods* / Q000706:statistics & numerical data; D011379:Prognosis; D011446:Prospective Studies; D019564:Unnecessary Procedures / Q000706:statistics & numerical data