Pattern of Lymph Node Metastasis in Endometrial Cancer: a Single Institution Experience
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ORIGINAL ARTICLE
Pattern of Lymph Node Metastasis in Endometrial Cancer: a Single Institution Experience S. Suchetha 1
&
Arun Peter Mathew 2 & P. Rema 1 & Shaji Thomas 2
Received: 27 April 2020 / Accepted: 15 September 2020 # Indian Association of Surgical Oncology 2020
Abstract Surgical staging remains the standard primary treatment of endometrial cancer. Lymph node metastasis is the most important prognostic factor which helps in deciding adjuvant treatment. Extensive lymphadenectomy is associated with increased incidence of morbidity. The role of lymphadenectomy in surgical staging is still controversial especially in early stage disease. The surgicopathological pattern of 155 patients with apparently stage 1 cancer endometrium who had undergone pelvic alone or pelvic and para-aortic lymph node dissection and its correlation to the grade of the tumour, myometrial infiltration and presence of peritoneal disease and incidence of peri-operative morbidity are analysed and described. Keywords Cancer endometrium . Lymphadenectomy . Sentinel lymph node mapping . Isolated para-aortic node metastasis . Complications
Introduction Endometrial cancer is the sixth common cancer among females in India and the incidence shows an increasing trend. Surgical staging remains the standard primary treatment for endometrial cancer and lymph node metastasis is the most important prognostic factor for deciding on adjuvant treatment [1, 2]. The role of pelvic and para-aortic lymphadenectomy during surgical staging is controversial especially in early stages of the disease [3, 4]. Risk of advanced stage disease by surgical staging of clinical stage 1 disease ranges from 17.6 to 26.7% [5]. Various practices of lymph node evaluation have been described and include complete pelvic and paraaortic lymphadenectomy, intraoperative palpation and debulking of enlarged nodes, selective lymphadenectomy and sentinel lymph node dissection, and some authors have even advised no lymphadenectomy in early stages [6]. The potential complications as thromboembolic events are not so common except in one report [7]. Incidence of lymph node * S. Suchetha [email protected] 1
Department of Gynaecologic Oncology, Regional Cancer Centre, Thiruvananthapuram, India
2
Department of Surgical oncology, Regional Cancer Centre, Thiruvananthapuram, India
metastasis is related to grade of the tumour, depth of myometrial infiltration and peritoneal disease. [8] Various scoring systems have been developed using these factors for deciding on lymph node dissection and adjuvant treatment. [9] We analysed the patterns of pelvic and para-aortic lymph node involvement among our patients with early endometrial cancers.
Objective To find out the incidence of lymph node metastasis in clinical stage 1 endometrial cancer and its relation to grade of the tumour, myometrial infiltration and peritoneal disease.
Materials and Methods All patients with stage I endometrial cancer (clinical and radiological) who had undergone surgical staging at our institute during 2010
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