Para-aortic lymphadenectomy can be omitted in most endometrial cancer patients at risk of lymph node metastasis

Objectives

To determine the predictive factors of para-aortic lymph node (PALN) metastasis in endometrial cancer (EC) and recommend a subgroup of patients who can safely forgo PALN dissection.

Methods

We analyzed a series of 255 patients who were at risk of lymph node metastasis and treated from June 2007 to June 2015. All patients underwent systematic pelvic and para-aortic lymphadenectomy.

Results

The median number of pelvic lymph nodes (PLN) and PALNs that were resected was 33 and 15, respectively. Fifty (19.6%) patients had LN metastasis—43 (16.9%) pelvic, 28 (11%) para-aortic, 21 (8.2%) pelvic and para-aortic, and 7 (2.7%) isolated PALN metastasis. PALN metastasis was significantly associated with PLN metastasis, the presence of lymphovascular space invasion, deep myometrial invasion (MI), and histological grade 3. In the multivariate analysis, only pelvic LN metastasis and deep MI remained independent risk factors of PALN metastasis. For patients without LN enlargement ± adnexal metastasis, when deep MI and PLN metastasis were absent, the risk of PALM was 0.8%.

Conclusions

Our series supports that PALN metastasis is a rare event in the absence of PLN metastasis and that most patients can safely forego PALN dissection. This subgroup can be identified by the combined absence of PLN metastasis and deep MI.

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