title: Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer.
abstract: OBJECTIVE
  Since 1999, patients with low risk endometrial cancer (EC) as defined by the Mayo criteria have preferably not undergone lymphadenectomy (LND) at our institution. Here we prospectively assess survival, sites of recurrence, morbidity, and cost in this low risk cohort.
  
  
  METHODS
  Cause-specific survival (CSS) was estimated using the Kaplan-Meier method and compared using the log-rank test. Complications were graded per the Accordion Classification. Thirty-day cost analyses were expressed in 2010 Medicare dollars.
  
  
  RESULTS
  Among 1393 consecutive surgically managed cases, 385 (27.6%) met inclusion criteria, accounting for 34.1% of type I EC. There were 80 LND and 305 non-LND cases. Complications in the first 30 days were significantly more common in the LND cohort (37.5% vs. 19.3%; P<0.001). The prevalence of lymph node metastasis was 0.3% (1/385). Over a median follow-up of 5.4 years only 5 of 31 deaths were due to disease. The 5-year CSS in LND and non-LND cases was 97.3% and 99.0%, respectively (P=0.32). None of the 11 total recurrences occurred in the pelvic or para-aortic nodal areas. Median 30-day cost of care was $15,678 for LND cases compared to $11,028 for non-LND cases (P<0.001). The estimated cost per up-staged low-risk case was $327,866 to $439,990, adding an additional $1,418,189 if all 305 non-LND cases had undergone LND.
  
  
  CONCLUSIONS
  Lymphadenectomy dramatically increases morbidity and cost of care without discernible benefits in low-risk EC as defined by the Mayo criteria. In these low-risk patients, hysterectomy with salpingo-oophorectomy alone is appropriate surgical management and should be standard of care.
authors: Division of Gynecologic Surgery, Mayo Clinic, Rochester, MN 55905, USA. dowdy.sean@mayo.edu
authors: S C
authors: SC
authors: Dowdy
authors: B J
authors: BJ
authors: Borah
authors: J N
authors: JN
authors: Bakkum-Gamez
authors: A L
authors: AL
authors: Weaver
authors: M E
authors: ME
authors: McGree
authors: L R
authors: LR
authors: Haas
authors: G L
authors: GL
authors: Keeney
authors: A
authors: A
authors: Mariani
authors: K C
authors: KC
authors: Podratz
mesh_terms: D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D016889:Endometrial Neoplasms / Q000191:economics / Q000401:mortality* / Q000601:surgery* / Q000628:therapy; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000191:economics* / Q000379:methods / Q000401:mortality*; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery*; D008207:Lymphatic Metastasis; D008875:Middle Aged; D009017:Morbidity; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D009367:Neoplasm Staging; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant; D012307:Risk Factors; D016019:Survival Analysis; D014481:United States