Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study
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Is lymph node dissection mandatory among early stage endometrial cancer patients? A retrospective study Guangmin Zhang1* , Hongyou Chen1, Yanying Liu1, Liyan Niu1, Liming Jin1, Dong Li1, Lihua Song1, Lifei Shang1, Xiangya Lin1, Fei Wang1, Fengtong Li1, Xinyu Zhang1, Xiaoyu Zhang1, Yan Gao1, Dongyu Qiu1, Yunpu Zhang2, Ren Na2 and Riguge Su2
Abstract Background: Whether routine lymph node dissection for early endometrial cancer is beneficial to survival is still controversial. However, surgeons usually perform lymph node dissection on all patients with early endometrial cancer. This study aimed to prove that the risk of lymph node metastasis, as defined by our standard, is very low in such patients and may change the current surgical practice. Methods: 36 consecutive patients who had staged surgery for endometrial cancer were collected. All eligible patients meet the following very low risk criteria for lymph node metastasis, including: (1) preoperative diagnosis of endometrial cancer (preoperative pathological diagnosis), (2) tumors confined to the uterine cavity and not beyond the uterine body, (3) PET-MRI lymph node metastasis test is negative. PET-MRI and pathological examination were used to assess the extent and size of the tumor, the degree of muscular invasion, and lymph node metastasis. Results: The median age at diagnosis was 52 years (range 35–72 years). The median tumor size on PET-MRI was 2.82 cm (range 0.66–6.37 cm). Six patients underwent robotic surgery, 20 underwent laparoscopic surgery, 8 underwent Laparoscopic-assisted vaginal hysterectomy, and 2 underwent vaginal hysterectomy. 23% (63.9%) patients had high-grade (i.e. 2 and 3) tumors. Among the 36 patients who underwent lymph node sampling, the median number of lymph nodes retrieved was 32 (range 9–57 nodules). No patient (0%) was diagnosed with lymph node metastasis. According to the policy of each institution, 8 patients (22.2%) received adjuvant therapy, and half of them also received chemotherapy (4 patients; 50%). Conclusions: None of the patients who met the criteria had a pathological assessment of lymph node metastasis. Omitting lymph node dissection may be reasonable for patients who meet our criteria. Keywords: Endometrial cancer, Lymph node dissection, Low risk, PET-MRI, Metastasis Background Endometrial cancer is the sixth most common cancer in women worldwide and the most common gynaecological malignancy in developed countries [1]. Wang et al. [2] have reported that about 73% of patients with *Correspondence: [email protected] 1 Chifeng Second Hospital, Chifeng 024000, Innermongolia, China Full list of author information is available at the end of the article
endometrial cancer are diagnosed in stage I, and the 5-year overall survival rate after surgery is 85% to 91%. The rate of lymph node metastasis in patients with endometrial cancer was reported to be less than 10% [3]. Thus, it is controversial whether all patients with early endometrial cancer need lymph node dissection (LND) [3–5]. LND not onl
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