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Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.

Methods

A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.

Results

Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.

Conclusion

Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer.

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Disclosure

We declare no conflict of interest for this study.

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Authors and Affiliations

  1. Department of Obstetrics and Gynecology, Hokkaido University Graduate School of Medicine, Sapporo, Japan

    Tetsuji Odagiri MD, Hidemichi Watari MD, PhD, Tatsuya Kato MD, Takashi Mitamura MD, PhD, Masayoshi Hosaka MD, PhD, Satoko Sudo MD, PhD, Mahito Takeda MD, PhD, Noriko Kobayashi MD, PhD, Peixin Dong MD, PhD, Masataka Kudo MD, PhD & Noriaki Sakuragi MD, PhD

  2. Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan

    Yukiharu Todo MD, PhD

Authors
  1. Tetsuji Odagiri MD
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  2. Hidemichi Watari MD, PhD
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  3. Tatsuya Kato MD
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  4. Takashi Mitamura MD, PhD
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  5. Masayoshi Hosaka MD, PhD
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  6. Satoko Sudo MD, PhD
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  7. Mahito Takeda MD, PhD
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  8. Noriko Kobayashi MD, PhD
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  9. Peixin Dong MD, PhD
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  10. Yukiharu Todo MD, PhD
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  11. Masataka Kudo MD, PhD
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  12. Noriaki Sakuragi MD, PhD
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Corresponding author

Correspondence to Hidemichi Watari MD, PhD.

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Fig. S1

Prevalence of LNM sites in five categories in surgically-stagedendometrial cancer (TIFF 60 kb)

Fig. S2

Single site LNM in surgically-staged endometrial cancer (TIFF 92 kb)

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Odagiri, T., Watari, H., Kato, T. et al. Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials. Ann Surg Oncol 21, 2755–2761 (2014). https://doi.org/10.1245/s10434-014-3663-0

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  • DOI: https://doi.org/10.1245/s10434-014-3663-0

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