title: Surgical staging for endometrial cancer in the elderly - is there a role for lymphadenectomy?
abstract: OBJECTIVE
  We sought to evaluate the effect of systematic lymphadenectomy (LND) on endometrial cancer-specific survival in an elderly population.
  
  
  METHODS
  Data were obtained from the Surveillance, Epidemiology, and End Results (SEER) program from 1988 to 2006. Women who underwent primary hysterectomy for non-serous, non-clear cell endometrial carcinoma were included. Women were stratified by age (<70, 70-79, and ≥ 80) and disease-specific survival (DSS) was analyzed via the Kaplan-Meier method and stratified by postoperative grade. Cohorts were compared using the log-rank test. In a simulated population, the disease-specific survival of women with pre-operative grade 1 endometrial carcinoma was calculated using a weighted average survival accounting for those upgraded at final pathology.
  
  
  RESULTS
  Endometrial cancer was identified in 5759 women ≥ 80 years old. Disease specific survival at 5 years for the LND and no LND groups was 93.4% and 94.5% (p=0.36) for grade 1, 84.4% and 85% (p=0.97) for grade 2, and 65.9% and 60.9% (p=0.002) for grade 3. In the simulated pre-operative grade 1 group, 5 year disease-specific survival (DSS) was 91% in the LND group and 92% in the no LND group.
  
  
  CONCLUSIONS
  In women older than 80, systematic lymphadenectomy is associated with improved DSS for high grade, but similar DSS for low grade endometrial cancer, consistent with what is seen with younger women. As there is no clear survival benefit to lymphadenectomy in elderly women presenting with low grade disease, the surgeon should carefully weigh the surgical risks and benefits in this patient population, which may be at higher risk for morbidity.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC 27710, USA. william.lowery@duke.edu
authors.forename: William J
authors.initials: WJ
authors.lastname: Lowery
authors.forename: Paola A
authors.initials: PA
authors.lastname: Gehrig
authors.forename: Emily
authors.initials: E
authors.lastname: Ko
authors.forename: Angeles Alvarez
authors.initials: AA
authors.lastname: Secord
authors.forename: Junzo
authors.initials: J
authors.lastname: Chino
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Havrilesky
mesh_terms: D000369:Aged, 80 and over; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy; D008197:Lymph Node Excision / Q000379:methods*; D060787:Neoplasm Grading; D009367:Neoplasm Staging / Q000379:methods*; D018426:SEER Program; D015996:Survival Rate; D014481:United States / Q000453:epidemiology