Pelvic Lymphadenectomy Does Not Improve Survival in Stage I Endometrial Cancer
Pelvic lymphadenectomy (removal of pelvic lymph nodes) may be valuable for staging in endometrial cancer; however, it does not improve survival rates in women with Stage I endometrial cancer, according to the results of a study published in the Journal of the National Cancer Institute.
Endometrial cancer is a cancer of the uterus and is the most frequently diagnosed gynecologic cancer in the United States. Fortunately, long-term survival rates are high for cancers detected and treated early.
Standard treatment for endometrial cancer includes a total abdominal hysterectomy (removal of the uterus) and bilateral salpingo-oophorectomy (removal of the fallopian tubes and ovaries).
The most common site of cancer spread in early-stage endometrial cancer is to the pelvic lymph nodes. A pelvic lymphadenectomy is a surgical procedure in which the pelvic lymph nodes are removed and examined to see if they contain cancer. In the past researchers have been uncertain whether pelvic lymphadenectomy improves survival in early-stage endometrial cancer.
Researchers from Italy conducted a multicenter clinical trial in which 514 women with Stage I endometrial cancer were randomly allocated to receive pelvic lymphadenectomy (264) or no lymphadenectomy (250). The median number of lymph nodes removed in the lymphadenectomy group was 30. Early and late postoperative complications were more common in the lymphadenectomy group, with 81 of these patients experiencing complications compared with 34 in the non-lymphadenectomy group.
Pelvic lymphadenectomy did improve surgical staging, as 13.3% of women in the lymphadenectomy group were found to have metastases compared with 3.2% in the non-lymphadenectomy group. However, both the five-year disease-free survival and five-year overall survival were similar in both groups: five-year disease-free survival was 81% in the lymphadenectomy group and 82% in the non-lymphadenectomy group, and five-year overall survival was 86% in the lymphadenectomy group and 90% in the non-lymphadenectomy group.
Based on these results, the authors concluded: “Although systematic pelvic lymphadenectomy statistically significantly improved surgical staging, it did not improve disease-free or overall survival.”
 Panici PB, Basile S, Maneschi F, et al. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical Trial. Journal of the National Cancer Institute. 2008; 100: 1707-1716.