title: Staging for endometrial cancer: The controversy around lymphadenectomy - Can this be resolved?
abstract: Endometrial cancer remains the most common malignancy of the female genital tract. Lymph node metastasis is one of the most important prognostic factors, and stratification into pelvic lymph node invasion (stage IIIC1) and para-aortic lymph node invasion (stage IIIC2) improved the predictive value of the 2009 International Federation of Gynecology and Obstetrics (FIGO) classification. Radiological examination methods such as magnetic resonance imaging and positron emission tomography-computed tomography do not have good-enough sensitivity to avoid lymphadenectomy for the assessment of lymph node invasion. Prediction scores are becoming increasingly valuable to exclude lymph node metastasis in low-risk groups, and biomarkers could help to identify patients with high-risk lymph node metastatic probability. The therapeutic role of lymph node dissection remains a matter of debate. Several end points can be considered to evaluate the opportunity of lymphadenectomy in endometrial cancer. First, we compare survival according to the realization, the extent, and the numbers of nodes removed during lymphadenectomy. Second, we assess the opportunity of lymphadenectomy in order to tailor adjuvant treatment modalities. Third, we analyze the surgical complication rate after pelvic lymphadenectomy.
authors.affiliation: Department of Obstetrics and Gynaecology, APHP Hôpital Bichat, Paris, France; Paris Diderot University Paris 07, Paris, France.
authors.forename: Martin
authors.initials: M
authors.lastname: Koskas
authors.affiliation: Department of Gynaecology Institut Curie, Paris, France.
authors.forename: Roman
authors.initials: R
authors.lastname: Rouzier
authors.affiliation: Gynecologic Oncology, University Hospitals Leuven, and Department of Oncology, KU Leuven, Leuven, Belgium. Electronic address: Frederic.amant@uzleuven.be.
authors.forename: Frederic
authors.initials: F
authors.lastname: Amant
mesh_terms: D000230:Adenocarcinoma / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D018262:Adenocarcinoma, Clear Cell / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D000231:Adenocarcinoma, Papillary / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D018269:Carcinoma, Endometrioid / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D002296:Carcinosarcoma / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology*; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D018297:Neoplasms, Cystic, Mucinous, and Serous / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D010388:Pelvis; D049268:Positron-Emission Tomography; D011379:Prognosis; D011859:Radiography
keywords: endometrial cancer; lymph node metastasis; lymphadenectomy; prediction; staging; survival