Lymphadenectomy versus no lymphadenectomy in endometrial carcinoma: a retrospective analysis of 410 patients.

Objective: Pelvic lymph nodes are the most common site of extrauterine spread in clinical early-stage endometrial cancer. International Federation of Gynecology and Obstetrics has mandated surgical evaluation of lymph nodes in endometrial cancer since 1988; however, the clinical impact of lymphadenectomy has never been addressed. Design: We reported a retrospective analysis in order to evaluate whether pelvic systematic lymph dissection improves overall and progression-free survival compared with no lymphadenectomy. Method: From 1991 through 2008, patients with endometrial carcinoma were evaluated using a log-rank statistic and a Cox multivariable regression analysis. All statistical tests were two-sided. Results: Of the 410 patients with a diagnosis of endometrial carcinoma, 390 underwent primary surgery. Of those who underwent surgery, 285 had endometrioid histology. One hundred and ninety (190) patients had surgery with no lymphadenectomy, whereas 95 had surgery with lymphadenectomy. Only 4 women revealed positive nodes. Median number of removed nodes was 14 in the lymphadenectomy group. The 5-year survival rate of 90% and 86% was achieved, respectively, for lymphadenectomy and no lymphadenectomy ( p¼0.501). Conclusions: Although systematic pelvic lymphadenectomy significantly improved surgical staging of women with clinical early-stage endometrial carcinoma by detecting a higher rate of patients with positive nodes, it did not improve overall survival