title: Patterns of recurrence in endometrial cancer patients at risk of lymph node metastasis or recurrence according to extent of lymphadenectomy.
abstract: OBJECTIVE
  The purpose of this study was to compare the patterns of recurrence in patients with risk of lymph node (LN) metastasis or recurrence according to the extent of lymphadenectomy (LND).
  
  
  METHODS
  We selected 257 patients with risk of LN metastasis or recurrence who underwent definitive surgery as the first treatment between 1995 and 2009. These patients underwent hysterectomy, bilateral salpingo-oophorectomy, and systematic pelvic lymphadenectomy (PLND) with or without para-aortic lymphadenectomy (PALND). We identified patients with recurrence and evaluated the patterns of recurrence according to the type of LND.
  
  
  RESULTS
  Among the 257 patients, 164 patients had systematic PLND only, and 93 patients had PLND with PALND. Regarding LN metastasis in PLND+PALND group, approximately 9.7% patients had involvement of para-aortic nodes. Thirty-six (14%) of the 257 patients showed recurrence. The rate of extrapelvic recurrence was significantly higher in the PLND group compared with the PLND+PALND group (96.0% vs 36.4%, respectively; P < 0.001). Using multivariate analysis, extent of LND was significantly related to extrapelvic recurrence (P = 0.004).
  
  
  CONCLUSIONS
  The incidence of extrapelvic recurrence was significantly higher in the PLND group than in the PLND+PALND group, which suggests that PALND decreases the risk of extrapelvic recurrence.
authors.affiliation: Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.
authors.forename: Ha-Jeong
authors.initials: HJ
authors.lastname: Kim
authors.forename: Tae-Joong
authors.initials: TJ
authors.lastname: Kim
authors.forename: Taejong
authors.initials: T
authors.lastname: Song
authors.forename: Min Kyu
authors.initials: MK
authors.lastname: Kim
authors.forename: Yoo-Young
authors.initials: YY
authors.lastname: Lee
authors.forename: Chel Hun
authors.initials: CH
authors.lastname: Choi
authors.forename: Jeong-Won
authors.initials: JW
authors.lastname: Lee
authors.forename: Duk-Soo
authors.initials: DS
authors.lastname: Bae
authors.forename: Byoung-Gie
authors.initials: BG
authors.lastname: Kim
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000556:secondary / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000556:secondary / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies