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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 3/2015

01-12-2015 | Gynecologic Oncology

Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery

Authors: Yves Borghesi, MD, Fabrice Narducci, MD, Lucie Bresson, MD, Emmanuelle Tresch, MSc, Jean Pierre Meurant, Sophie Cousin, MD, Abel Cordoba, MD, Benjamin Merlot, MD, Eric Leblanc, MD

Published in: Annals of Surgical Oncology | Special Issue 3/2015

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Abstract

Purpose

In November 2010, the French National Cancer Institute published new guidelines for managing endometrial cancer. Pelvic lymphadenectomy is not indicated for preoperative low–intermediate risk type 1 endometrial cancer, and high-risk patients should undergo secondary surgery with para-aortic lymphadenectomy. This study evaluated these new guidelines with regard to overall survival (OS), relapse-free survival (RFS), and morbidity for patients with low–intermediate risk disease.

Methods

We evaluated all type 1 endometrial cancer patients with low–intermediate risk of recurrence who were treated from 1 January 1997 through 31 December 2012. All patients were classified according to the 2009 International Federation of Gynecology and Obstetrics staging criteria and the European Society for Medical Oncology.

Results

Overall, 230 patients were included (159 before and 71 after the new guidelines were issued). Pelvic lymphadenectomies were performed before and after the new guidelines in 77.4 and 28.6 % of patients, respectively (p < 0.001). After 2010, eight patients also underwent secondary surgery, which consisted of a para-aortic lymphadenectomy for lymphovascular space invasion (LVSI). This second surgery changed the adjuvant treatment for one patient. OS and RFS were similar between both groups, and no difference in morbidity was observed between the groups. LVSI was an independent factor for OS [hazard ratio (HR) 7.2, 95 % CI 3.1–17; p < 0.001] and RFS (HR 3.7, 95 % CI 1.6–8.5; p < 0.003).

Conclusions

Fewer pelvic lymphadenectomies in low–intermediate risk patients did not affect OS, RFS, or morbidity, including patients with secondary surgery. We must gather additional data with a longer follow-up period to not only confirm our results but to also fully investigate the paradoxical absence of decreased morbidity that our study has shown.
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Metadata
Title
Managing Endometrial Cancer: The Role of Pelvic Lymphadenectomy and Secondary Surgery
Authors
Yves Borghesi, MD
Fabrice Narducci, MD
Lucie Bresson, MD
Emmanuelle Tresch, MSc
Jean Pierre Meurant
Sophie Cousin, MD
Abel Cordoba, MD
Benjamin Merlot, MD
Eric Leblanc, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue Special Issue 3/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4798-3

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