Diagnostic approach and therapeutic management in early-stage endometrial cancer
The effectiveness of pelvic and para-aortic lymphadenectomy in the morbidity of patients affected by early-stage endometrial carcinoma (EC) is the subject of this study.
Ninety-two cases with endometrial cancer that underwent para-aortic and pelvic lymphadenectomy, from June 1995 to June 2006, were studied and compared with 30 cases of patients with endometrial cancer without lymphadenectomy.
According to the results, systematic pelvic and para-aortic lymphadenectomies improved disease-free and overall survival rates among the patients with endometrial cancer. The mean number of removed para-aortic lymph nodes was 19.01 +/- 5.88, whereas the mean number of removed iliac lymph nodes was 32.94 +/- 6.69. Forty-two and 31 metastatic iliac and para-aortic nodes were found, respectively. No surgery-related deaths and major intraoperative injuries occurred. The frequency and the type of postoperative complications were not affected by the performance of lymphadenectomy. The morbidity rate was 6.2%, similar to the group without lymphadenectomy (5.79%). No recurrence occurred in the group with lymphadenectomy, while in the other group the recurrence rate was 23.3%.
Lymph nodes metastases can be observed in early stages of EC. Pelvic and para-aortic lymphadenectomies seems to provide profound information about the Stage of the disease and the patient's survival, identifying which patients are suitable for supplementary treatment, without significant clinical increase of morbidity.
Available from: Katarzyna Terlikowska
- "Several studies have compared outcomes in patients with early stage endometrial cancer with and without systematic lymphadenectomy   . Retrospective single-center studies recommend lymphadenectomy for all grades of tumor . "
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The aim of the study was to establish whether preoperative serum levels of HE4 and CA125 could be a good predictor for lymphadenectomy in the early stage of endometrioid adenocarcinoma of the uterus.
Material and methods:
Preoperative serum HE4 and CA125 were measured in 78 postmenopausal patients treated surgically. The ROC curves were generated to determine the optimal cutoff values of HE4 and CA125 levels with optimum sensitivity and specificity for the prediction of lymphadenectomy.
Based on ROC curve, we found that the HE4 value of 78pmol/l is the best cutoff to identify candidates who may require lymphadenectomy with the sensitivity of 86.6% and the specificity of 67.2% (NPV=88.4% and PPV=51.2%). The area under the curve (AUC) equals 0.814 (95% CI=0.721-0.886). The cutoff level of CA125 that shows the prognostic indices is 26U/ml, with the sensitivity of 66.6% and the specificity of 61.2% (NPV=69.4% and PPV=44.3%). For CA125 the AUC amounts to 0.671 (95% CI=0.568-0.764). We also found a statistically significant difference, comparing HE4 and CA125 AUC (0.814 vs. 0.671, respectively, p<0.001). The combination of HE4 and CA125 established in our study as the cutoff point has the sensitivity of 81.2% and the specificity of 65.9% with NPV=83.4% and PPV=47.9%.
Our findings indicate that in the early stage of endometrioid endometrial cancer, HE4 can serve as a preoperative tool that can help to identify postmenopausal women who may require lymphadenectomy.
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ABSTRACT: The aim of this study was to evaluate the complication rate of pelvic and para-aortic lymphadenectomy in the management of endometrial cancer following the changes to the recommendations of INCa 2010. This is a retrospective study of 208 patients operated for endometrial cancer between July 2010 and March 2014 in two referral centers. Eighty lymphadenectomy were performed, 65 with hysterectomy and bilateral annexectomy and 18 lymphadenectomy were performed for restaging. Complications assessment is based on the Dindo Clavien classification. We report 17 severe complications (grade 3a and over) (P<0.001), including 14 among patients receiving lymphadenectomy. Morbidity increases with the number of lymphnodes removed and their positivity (P<0.001). The para-aortic lymphadenectomy is primarily responsible for complications (P <0.001). We describe 7 lower limbs lymphedema, 12 nerve injuries, 8 ileus, 5 venous or arterial thromboembolism, 17 blood transfusions, 13 lymphoceles including 9 infected. The rate of intraoperative complications on a first lymphadenectomy is 8% while it reached 22% for restaging. Restaging is significantly more at risk of serious complications (P=0.03) with two deaths. Twenty-four chronic disorders with impaired quality of life (2 without lymphadenectomy) are reported. They are present in 50% of restaging (P=0.033 compared to first lymphadenectomy). Lymphadenectomy is a source of severe morbidity (17.5%) with 2.5% mortality. The benefit of this surgery should probably be discussed again.
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