Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence

Abstract

The aim of the present review is to summarize the current evidence on the role of pelvic and para-aortic lymphadenectomy in endometrial cancer. In 1988, the International Federation of Obstetrics and Gynecology recommended surgical staging for endometrial cancer patients. However, 25 years later, the role of lymph node dissection remains controversial. Although the findings of two large independent randomized trials suggested that pelvic lymphadenectomy provides only adjunctive morbidity with no clear influence on survival outcomes, the studies have many pitfalls that limit interpretation of the results. Theoretically, lymphadenectomy may help identify patients with metastatic dissemination, who may benefit from adjuvant therapy, thus reducing radiation-related morbidity. Also, lymphadenectomy may eradicate metastatic disease. Because lymphatic spread is relatively uncommon, our main effort should be directed at identifying patients who may potentially benefit from lymph node dissection, thus reducing the rate of unnecessary treatment and associated morbidity. This review will discuss the role of lymphadenectomy in endometrial cancer, focusing on patient selection, extension of the surgical procedure, postoperative outcomes, quality of life and costs. The need for new surgical studies and efficacious systemic drugs is recommended.

Keywords: aortic lymphadenectomy; endometrial cancer; pelvic lymphadenectomy; staging; survival.

Figure 1

Algorithm for surgical management of endometrial cancer at our institution. In the case of type 2 endometrial cancer, omentectomy is required. No lymphadenectomy is done in the patients with stage IV cancer. BSO, bilateral salpingo-oophorectomy.

Figure 2

Risk of lymph node metastasis and lymph node recurrence according to preoperative and operative findings. LN, lymph node; mts, metastases; TD, tumor diameter. (Data from AlHilli et al..)

Figure 3

Risk of lymph node metastasis. *Para-aortic lymph node metastases may be associated with lymphovascular space invasion. EC, endometrial cancer; LN, lymph node; MI, myometrial invasion; mts, metastases; PA, para-aortic; PL, pelvic. (Adapted from Kumar et al.,^, with permission.)