title: Paraaortic lymphadenectomy in intermediate to high risk uterine endometrioid cancer : a retrospective evaluation.
abstract: OBJECTIVE
  To investigate the impact on survival of paraaortic lymph node dissection (PALND) added to pelvic lymph node dissection (PLND) in patients with intermediate to high-risk endometrioid endometrial cancer (EC ). Surgical parameters and perioperative morbidity have been explored as well.
  
  
  METHODS
  We retrospectively identified all eligible patients that received LND as part of their primary treatment at a single institution from January 2000 to December 2010. Survival curves for overall (OS), disease-specific (DSS) and disease-free (DFS) survival were plotted by the Kaplan-Meier method and compared by the log-rank test. Cox proportional hazards regression was used for multivariable analysis for OS and DSS.
  
  
  RESULTS
  93 patients underwent PLND plus PALND in their initial operation (PALND group) and 177 patients underwent PLND only (no-PALND group). Patients in the non-PALND group were older, more obese and had higher rates of comorbidities. The median number of PLN and PALN retrieved were 26 and 13 respectively. Isolated PALN metastasis was seen in 2 (2.1%) patients. PALND was associated with longer operative time, higher transfusion rate and longer hospital stay. PALND group had a benefit in OS (p=0.033), which did not persist in DSS or DFS. Furthermore, the type of LND did not significantly improve either OS or DSS according to the multivariate analysis results.
  
  
  CONCLUSIONS
  PALND had no therapeutic value per se in women with intermediate to high risk endometrioid tumors and the improvement seen in OS should rather be attributed to the better medical status of women who received PALND.
authors.affiliation: Democritus University of Thrace, Department of Obstetrics and Gynaecology, Alexandroupolis, Greece.
authors.forename: Panagiotis
authors.initials: P
authors.lastname: Tsikouras
authors.forename: Zacharoula
authors.initials: Z
authors.lastname: Koukouli
authors.forename: Stefanos
authors.initials: S
authors.lastname: Zervoudis
authors.forename: Bachar
authors.initials: B
authors.lastname: Manav
authors.forename: Georgios
authors.initials: G
authors.lastname: Iatrakis
authors.forename: Anastasios
authors.initials: A
authors.lastname: Liberis
authors.forename: Georgios
authors.initials: G
authors.lastname: Galazios
authors.forename: Tobias
authors.initials: T
authors.lastname: Alexander Teichmann
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D018269:Carcinoma, Endometrioid / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018450:Disease Progression; D018572:Disease-Free Survival; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005858:Germany; D006801:Humans; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008197:Lymph Node Excision; D008207:Lymphatic Metastasis; D008875:Middle Aged; D015999:Multivariate Analysis; D061646:Operative Time; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome