title: [Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer].
abstract: The aim of this study was to evaluate the complication rate of pelvic and para-aortic lymphadenectomy in the management of endometrial cancer following the changes to the recommendations of INCa 2010. This is a retrospective study of 208 patients operated for endometrial cancer between July 2010 and March 2014 in two referral centers. Eighty lymphadenectomy were performed, 65 with hysterectomy and bilateral annexectomy and 18 lymphadenectomy were performed for restaging. Complications assessment is based on the Dindo Clavien classification. We report 17 severe complications (grade 3a and over) (P<0.001), including 14 among patients receiving lymphadenectomy. Morbidity increases with the number of lymphnodes removed and their positivity (P<0.001). The para-aortic lymphadenectomy is primarily responsible for complications (P <0.001). We describe 7 lower limbs lymphedema, 12 nerve injuries, 8 ileus, 5 venous or arterial thromboembolism, 17 blood transfusions, 13 lymphoceles including 9 infected. The rate of intraoperative complications on a first lymphadenectomy is 8% while it reached 22% for restaging. Restaging is significantly more at risk of serious complications (P=0.03) with two deaths. Twenty-four chronic disorders with impaired quality of life (2 without lymphadenectomy) are reported. They are present in 50% of restaging (P=0.033 compared to first lymphadenectomy). Lymphadenectomy is a source of severe morbidity (17.5%) with 2.5% mortality. The benefit of this surgery should probably be discussed again.
authors.affiliation: Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Agar
authors.affiliation: Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France.
authors.forename: Anne-Cécile
authors.initials: AC
authors.lastname: Philippe
authors.affiliation: Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Bourdel
authors.affiliation: Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Rabischong
authors.affiliation: Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Canis
authors.affiliation: Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Le Bouedec
authors.affiliation: Délégation recherche clinique et innovation, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France.
authors.forename: Aurélien
authors.initials: A
authors.lastname: Mulliez
authors.affiliation: Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France.
authors.forename: Jacques
authors.initials: J
authors.lastname: Dauplat
authors.affiliation: Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France. Electronic address: christophe.pomel@cjp.fr.
authors.forename: Christophe
authors.initials: C
authors.lastname: Pomel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal; D001803:Blood Transfusion / Q000706:statistics & numerical data; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data; D045823:Ileus / Q000209:etiology; D035002:Lower Extremity; D008197:Lymph Node Excision / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D008209:Lymphedema / Q000209:etiology; D008210:Lymphocele / Q000209:etiology; D008875:Middle Aged; D010388:Pelvis; D059348:Peripheral Nerve Injuries / Q000209:etiology; D011788:Quality of Life; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D054556:Venous Thromboembolism / Q000209:etiology
keywords: Cancer de l’endomètre; Complications; Endometrial cancer; Facteurs de morbidité; Lombo-aortic lymphadenectomy; Lymphadénectomie lombo-aortique; Lymphadénectomie pelvienne; Pelvic lymphadenectomy; Risk factors