title: Para-aortic lymph node dissection for women with endometrial adenocarcinoma and intermediate- to high-risk tumors: does it improve survival?
abstract: OBJECTIVE
  Literature suggests that para-aortic lymphadenectomy (para-aortic lymph node dissection [PALND]) has a therapeutic benefit for women with intermediate- to high-risk endometrial adenocarcinoma. We hypothesized that the observed survival advantage of PALND is a reflection of the general health of the patient rather than a therapeutic benefit of surgery.
  
  
  METHODS
  Women with intermediate- to high-risk endometrial adenocarcinoma diagnosed from 2002 to 2009 at a single institution were identified. Medical comorbidities, pathology, and survival information were abstracted from the medical record. The χ test or the t test was used for univariate analysis. Overall survival (OS) and disease-specific survival (DSS) were calculated using the Kaplan-Meier method.
  
  
  RESULTS
  A total of 253 women with a mean age of 64 years were identified. Of these women, 174 had a pelvic lymphadenectomy (pelvic lymph node dissection [PLND]) and 82 had PLND and PALND. The rate of positive nodes was 13% (23/174) for the women who had PLND and was 7% (6/82) for those who had PLND and PALND. Only 1.2% (1/82) of the women who had PLND and PALND had negative pelvic but positive para-aortic nodes. The patients who had PALND had a lower body mass index and were less likely to have significant medical comorbidities. The patients who had PALND had improved 5-year OS (96% vs 82%, P = 0.007) but no difference in 5-year DSS (96% vs 89%, P value = not significant).
  
  
  CONCLUSIONS
  Women with intermediate- to high-risk endometrial adenocarcinoma who undergo PALND have improved OS but no improvement in DSS. The lack of difference in DSS supports the hypothesis that underlying comorbidities as opposed to lack of PALND result in poorer outcome.
authors.affiliation: *Thornton Gynecology Oncology Service, Department of Obstetrics and Gynecology, University of Virginia Health System, Charlottesville, VA; †Department of Obstetrics and Gynecology, Magee Womens Hospital, University of Pittsburgh Medical Center, Pittsburgh, PA; ‡USA Mitchell Cancer Center, Mobile, AL; and §Department of Obstetrics and Gynecology, University of Maryland Medical Center, Baltimore, MD.
authors.forename: Madeleine
authors.initials: M
authors.lastname: Courtney-Brooks
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Scalici
authors.forename: A Rauda
authors.initials: AR
authors.lastname: Tellawi
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Cantrell
authors.forename: Linda R
authors.initials: LR
authors.lastname: Duska
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016889:Endometrial Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008875:Middle Aged; D012042:Registries; D014768:Virginia / Q000453:epidemiology