title: Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery.
abstract: OBJECTIVE
  In November 2010, the French National Cancer Institute published new guidelines for managing endometrial cancer. Pelvic lymphadenectomy is not indicated for preoperative low-intermediate risk type 1 endometrial cancer, and high-risk patients should undergo secondary surgery with para-aortic lymphadenectomy. This study evaluated these new guidelines with regard to overall survival (OS), relapse-free survival (RFS), and morbidity for patients with low-intermediate risk disease.
  
  
  METHODS
  We evaluated all type 1 endometrial cancer patients with low-intermediate risk of recurrence who were treated from 1 January 1997 through 31 December 2012. All patients were classified according to the 2009 International Federation of Gynecology and Obstetrics staging criteria and the European Society for Medical Oncology.
  
  
  RESULTS
  Overall, 230 patients were included (159 before and 71 after the new guidelines were issued). Pelvic lymphadenectomies were performed before and after the new guidelines in 77.4 and 28.6 % of patients, respectively (p < 0.001). After 2010, eight patients also underwent secondary surgery, which consisted of a para-aortic lymphadenectomy for lymphovascular space invasion (LVSI). This second surgery changed the adjuvant treatment for one patient. OS and RFS were similar between both groups, and no difference in morbidity was observed between the groups. LVSI was an independent factor for OS [hazard ratio (HR) 7.2, 95 % CI 3.1-17; p < 0.001] and RFS (HR 3.7, 95 % CI 1.6-8.5; p < 0.003).
  
  
  CONCLUSIONS
  Fewer pelvic lymphadenectomies in low-intermediate risk patients did not affect OS, RFS, or morbidity, including patients with secondary surgery. We must gather additional data with a longer follow-up period to not only confirm our results but to also fully investigate the paradoxical absence of decreased morbidity that our study has shown.
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France. yves.borghesi@hotmail.fr.
authors: Yves
authors: Y
authors: Borghesi
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Fabrice
authors: F
authors: Narducci
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Lucie
authors: L
authors: Bresson
authors: Department of Biostatistics, Cancer Center Oscar Lambret, Lille, France.
authors: Emmanuelle
authors: E
authors: Tresch
authors: Department of Biostatistics, Cancer Center Oscar Lambret, Lille, France.
authors: Jean Pierre
authors: JP
authors: Meurant
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Sophie
authors: S
authors: Cousin
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Abel
authors: A
authors: Cordoba
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Benjamin
authors: B
authors: Merlot
authors: Department of Gynecology Oncology, Cancer Center Oscar Lambret, Lille, France.
authors: Eric
authors: E
authors: Leblanc
mesh_terms: D000368:Aged; D015331:Cohort Studies; D019468:Disease Management; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D010386:Pelvic Neoplasms / Q000556:secondary / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011379:Prognosis; D024162:Second-Look Surgery; D015996:Survival Rate