Isolated para-aortic lymph node metastasis in completely staged endometrioid type endometrial cancer

Purpose: Majority of gynecologic oncologists perform low para-aortic dissection, while only one in ten incorporated para-aortic dissection to the level of renal vessels. The aim of this study is to demonstrate the necessity of para-aortic lymph node dissection (LND) in the surgical management of the endometrioid type endometrial cancer (EC). Materials and Methods: Endometrioid type EC patients who were operated at the present institution were included in the study. The patients were stratified according to the modified Mayo Clinic risk criteria. According to these criteria, the authors identified each patient as low risk or high risk for extra-uterine disease spread on final pathology reports. Low risk criteria for nodal disease were identified as grade 1 or 2 endometrioid type disease, equal or less than 1/2 myometrial invasion (MI), and greatest tumor diameter equal or less than 2 cm. Results: Three hundred eighty-six patients were operated with the diagnosis of endometrioid type EC. Two hundred forty-seven patients had high risk factors for extra-uterine disease; thus, complete surgical staging was performed to this group. The remaining 139 patients had low risk criteria. The median follow-up time was 35 months (minimum two months, maximum 97 months). Twenty-six patients (10.5%) died of disease during the follow-up period. Two hundred fifteen patients (87%) had negative nodes, while remaining 32 (12.6%) patients had pelvic and/or para-aortic LN metastasis. Thirteen patients (40.6%) had only pelvic LN involvement (Stage 3C1), 19 patients (59.4%) had either pelvic and/or para-aortic LN involvement (Stage 3C2), and six patients (18.6%) had isolated para-aortic LN involvement. Conclusion: The present authors advocate the value of para-aortic LND in surgical management of EC, and retroperitoneal LND should not be limited to pelvic nodes, a systematic para-aortic dissection up to left renal vein should be performed for the patients with at least one risk factor for nodal disease.

Endometrial cancer; Nodal spread; Lymph node dissection; Endometrioid type.

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