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Para‐aortic lymphadenectomy can be omitted in most endometrial cancer patients at risk of lymph node metastasis
Author(s) -
Baiocchi Glauco,
Faloppa Carlos Chaves,
Mantoan Henrique,
Camarço Willian Ricardo,
BadiglianFilho Levon,
Kumagai Lillian Yuri,
De Brot Louise,
da Costa Alexandre Andre Balieiro Anastacio
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24651
Subject(s) - medicine , metastasis , endometrial cancer , lymphadenectomy , dissection (medical) , lymphovascular invasion , lymph node , oncology , radiology , cancer
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.