THE ROLE OF LYMPHADENECTOMY IN ENDOMETRIAL CANCER
Abstract
Background. Lymphatics are the main pathway for distant spread of endometrial cancer. The node groups most commonly involved are located along the iliac and retroperitoneal vessels. Therefore, pelvic and aortic lymphadenectomy are performed for staging and therapeutic purposes.
Methods. Lymphadenectomy is indicated in patients having moderate to high risk for lymph node metastasis (grade 2 and 3 tumor, myoinvasion > 50%, clear cell, squamous and serous papillary tumors). In patients with low risk for node metastasis (myometrial invasion absent or < 50% with grades 1 lymphadenectomy is questionable. Patterns of lymphatic spread indicate that lymphadenectomy should include superficial obturator, external iliac, and common iliac nodes. Internal iliac, deep obturator, deep common iliac, presacral and aortic nodes should be removed only from patients having node metastases at frozen section.
Conclusions. A thorough staging lymphadenectomy provides more accurate information to select patients who are candidates for adjuvant treatment. The main role of this procedure is in individualized tailoring of adequate adjuvant treatment.
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