title: Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer.
abstract: OBJECTIVE
  Patients with high-risk early or advanced endometrial cancer (EC) are at high risk for lymph node (LN) metastases. However, both the anatomical pattern of the LN metastases and also the therapeutic value of systematic LN dissection remain a field of discussion and controversy.
  
  
  METHODS
  We performed an exploratory analysis of patients with high-risk or advanced EC who underwent systematic pelvic and para-aortic lymphadenectomy in two tertiary referral centers for gynecological malignancies.
  
  
  RESULTS
  One hundred and twenty-eight completely surgically staged patients underwent systematic pelvic and para-aortic lymphadenectomy for high-risk or advanced EC. A median of 29 and 21.5 LN was harvested in the pelvis and in the para-aortic region, respectively. Overall, 27 patients (21.1 %) had positive LN: 18 % showed positive pelvic LN and 14.8 % positive para-aortic LN; while 3.1 % showed isolated para-aortic LN metastases. Five-year overall survival was 70 versus 30 % in LN-negative versus LN-positive patients (p < 0.01). LN-status was the only factor significantly associated with overall survival [HR: 3.67 (95 % CI 1.48-9.11); p = 0.01] in a multivariate Cox regression model.
  
  
  CONCLUSIONS
  Patients with high-risk or advanced EC were at a high-risk for LN metastases. Anatomical distribution of positive LN indicates that lymphadenectomy, when performed, should contain both pelvic and para-aortic areas up to the renal vessels for an accurate assessment of all potential positive LN.
authors.affiliation: Department of Gynecology and Obstetrics, Charité Campus Virchow-Klinikum, Berlin, Germany.|Department of Gynecology, Imperial College London, London, UK.
authors.forename: Christina
authors.initials: C
authors.lastname: Fotopoulou
authors.affiliation: Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany.|Department of Gynecology and Obstetrics, Goethe University of Frankfurt, Frankfurt, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: El-Balat
authors.affiliation: Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany.|Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: du Bois
authors.affiliation: Department of Gynecology and Obstetrics, Charité Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Jalid
authors.initials: J
authors.lastname: Sehouli
authors.affiliation: Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany.|Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany.
authors.forename: Philipp
authors.initials: P
authors.lastname: Harter
authors.affiliation: Department of Gynecology and Obstetrics, Charité Campus Virchow-Klinikum, Berlin, Germany.|Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany.
authors.forename: Mustafa Z
authors.initials: MZ
authors.lastname: Muallem
authors.affiliation: Department of Gynecology and Obstetrics, Charité Campus Virchow-Klinikum, Berlin, Germany.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Krätschell
authors.affiliation: Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany.|Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Traut
authors.affiliation: Department of Gynecology and Gynecologic Oncology, HSK, Dr. Horst-Schmidt Klinik Wiesbaden, Wiesbaden, Germany. f.heitz@kliniken-essen-mitte.de.|Department of Gynecology and Gynecologic Oncology, Kliniken Essen-Mitte, Evangelische Huyssens-Stiftung/Knappschaft GmbH, Henricistrasse 92, 45136, Essen, Germany. f.heitz@kliniken-essen-mitte.de.
authors.forename: Florian
authors.initials: F
authors.lastname: Heitz
mesh_terms: D000328:Adult; D000368:Aged; D001011:Aorta / Q000473:pathology / Q000601:surgery; D016889:Endometrial Neoplasms / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008197:Lymph Node Excision; D008198:Lymph Nodes / Q000473:pathology* / Q000601:surgery; D008207:Lymphatic Metastasis / Q000473:pathology*; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology; D012187:Retroperitoneal Space / Q000473:pathology; D016896:Treatment Outcome
keywords: Endometrial cancer; Lymph node metastasis; Lymphadenectomy; Prognosis; Systematic pelvic and para-aortic lymphadenectomy