Factors influencing the number of pelvic and para-aortic lymph nodes removed in surgical treatment of endometrial and ovarian cancer.
OBJECTIVE
This study aimed to determine the number of lymph nodes (LNs) removed in patients who underwent abdominal complete systematic pelvic and para-aortic lymphadenectomy and to identify factors that contribute to disparity in the number of LNs removed.


METHODS
We retrospectively reviewed 260 patients with endometrial cancer and ovarian cancer between 1997 and 2011. All pelvic and para-aortic LNs were submitted as 25 separate packets. The correlations of the number of LNs with age, year of surgery, the operating surgeon, pathologist, body mass index (BMI), histology, clinical stage, operating time, blood loss, and lymph node metastasis were investigated.


RESULTS
The median number of LNs removed was 45 pelvic (17-92) and 25 para-aortic (6-69) LNs. Among pelvic LNs, the common iliac nodes were the most frequently removed followed by the obturator nodes. The median number of the left upper para-aortic LNs between the left renal vein and the inferior mesenteric artery was highest among para-aortic LNs. There were significant correlations between the total number of LNs removed and age (P = 0.036), histology (clear vs serous; P = 0.015), and BMI (P < 0.0001) in ovarian cancer. Features associated with higher LN count on multivariate linear regression analysis included younger patients (P = 0.038) and higher BMI (P = 0.012).


CONCLUSIONS
Age and BMI are independently associated with higher LN counts during LN dissection in ovarian cancer. The present study results may be important when using LN counts as a surrogate for adequate lymphadenectomy.
Department of Obstetrics and Gynecology, Sapporo City General Hospital, Sapporo, Japan. hitoshi.hareyama@doc.city.sapporo.jp
Hitoshi
H
Hareyama
Kumiko
K
Ito
Sawako
S
Watanabe
Minako
M
Hakoyama
Akiko
A
Uchida
Kikuo
K
Oku
Yukio
Y
Watanabe
Yukitoki
Y
Hayakashi
Emi
E
Hirayama
Kazuhiko
K
Okuyama
D002288:Adenocarcinoma, Mucinous / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology / Q000601:surgery; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods* / Q000706:statistics & numerical data; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D055815:Young Adult