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Review
. 2021 Mar;32(2):e25.
doi: 10.3802/jgo.2021.32.e25. Epub 2021 Jan 7.

Lymphadenectomy issues in endometrial cancer

Yosuke Konno  1 , Hiroshi Asano  1 , Ayumi Shikama  2 , Daisuke Aoki  3 , Michihiro Tanikawa  4 , Akinori Oki  5 , Koji Horie  6 , Akira Mitsuhashi  7 , Akira Kikuchi  8 , Hideki Tokunaga  9 , Yasuhisa Terao  10 , Toyomi Satoh  2 , Kimio Ushijima  11 , Mitsuya Ishikawa  12 , Nobuo Yaegashi  9 , Hidemichi Watari  13
Affiliations
Review

Lymphadenectomy issues in endometrial cancer

Yosuke Konno et al. J Gynecol Oncol. 2021 Mar.

Abstract

Objectives: This review aims to introduce preoperative scoring systems to predict lymph node metastasis (LNM) and ongoing clinical trials to investigate the therapeutic role of lymphadenectomy for endometrial cancer.

Methods: We summarized previous reports on the preoperative prediction models for LNM and evaluated their validity to omit lymphadenectomy in our recent cohorts. Next, we compared characteristics of two ongoing lymphadenectomy trials (JCOG1412, ECLAT) to examine the survival benefit of lymphadenectomy in endometrial cancer, and described the details of JCOG1412.

Results: Lymphadenectomy has been omitted for 64 endometrial cancer patients who met low-risk criteria to omit lymphadenectomy using our scoring system (LNM score) and no lymphatic failure has been observed. Other two models also produced comparable results. Two randomized phase III trials to evaluate survival benefit of lymphadenectomy are ongoing for endometrial cancer. JCOG1412 compares pelvic lymphadenectomy alone with pelvic and para-aortic lymphadenectomy to evaluate the therapeutic role of para-aortic lymphadenectomy for patients at risk of LNM. For quality assurance of lymphadenectomy, we defined several regulations, including lower limit of the number of resected nodes, and submission of photos of dissected area to evaluate thoroughness of lymphadenectomy in the protocol. The latest monitoring report showed that the quality of lymphadenectomy has been well-controlled in JCOG1412.

Conclusion: Our strategy seems reasonable to omit lymphadenectomy and could be generalized in clinical practice. JCOG1412 is a high-quality lymphadenectomy trial in terms of the quality of surgical procedures, which would draw the bona-fide conclusions regarding the therapeutic role of lymphadenectomy for endometrial cancer.

Keywords: Clinical Trial; Endometrial Cancer; Lymphadenectomy; Survival.

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Conflict of interest statement

No potential conflict of interest relevant to this article was reported.

Figures

Fig. 1
Fig. 1. JCOG1412 trial scheme.
BSO, salpingo-oophorectomy; PALX, para-aortic lymphadenectomy; PLX, pelvic lymphadenectomy; PS, performance status; TAH, total abdominal hysterectomy; TC, paclitaxel + carboplatin; Tx, treatment.
See this image and copyright information in PMC

References

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