Determinants of pelvic and para-aortic lymph node metastasis in endometrial cancer and its role in tailoring lymphadenectomy

• Authors: Hussein Fakhry , Gamal Amira , Doaa Wadie , Anwar Tawfik Amin , Murad Jabir , Ikuo Konishi , Tanri Shiozawa , Ahmed Sekotory , Tarek M. Elsaba

Title variants

PL

Wyznaczniki przerzutów do węzłów chłonnych miedniczych i okołoaortalnych u pacjentek z rakiem błony śluzowej trzonu macicy i ich rola w ustalaniu zakresu limfadenektomii

• Languages of publication: EN

Abstracts

EN

Background: The International Federation of Gynecology and Obstetrics (FIGO) decided to adopt surgical staging for endometrial cancer including systemic pelvic and para-aortic lymph node dissection in 1988; however, the extent of an optimal lymphadenectomy and which subgroup of patients would benefit are still debatable issues. The purpose of this study was to evaluate the incidence and distribution of pelvic and aortic lymph node metastases in endometrial cancer and to study various clinicopathologic variables affecting lymph node metastasis in endometrial cancer and their role in tailoring lymphadenectomy. Methods: This retrospective study included patients with endometrial cancer that were admitted to the Obstetrics and Gynecology Department of Shinshu University Hospital, Japan, and South Egypt Cancer Institute, Assiut University, Egypt, between June 2005 and May 2014. All patients underwent pelvic lymph node and para-aortic lymph node dissection as part of the primary surgery during the study period. Demographic and clinicopathological data were collected and analyzed in relation to pelvic lymph node and para-aortic lymph node metastasis. Results: Seventy-eight patients (35 patients from Japan and 43 patients from Egypt) with endometrial cancer with FIGO stage I–IV and with all histopathological cell types and tumor grades were included. Pelvic lymph node metastases were significantly correlated with advanced disease (stage III and IV), endometroid carcinoma, myometrial invasion >1/2, adnexal involvement and lymphovascular space invasion. Para-aortic lymph node metastases were significantly correlated with advanced disease (stage III and IV), myometrial invasion >1/2, adnexal involvement and lymphovascular space invasion. Conclusion: Our study concluded that lymphadenectomy in patients with endometrial cancer can be tailored according to risk stratification for lymph node metastasis. So, in low risk patients lymphadenectomy can be omitted to avoid operative complications.

PL

Wstęp: W 1988 roku Międzynarodowa Federacja Ginekologii i Położnictwa (International Federation of Gynecology and Obstetrics, FIGO) zdecydowała o  przyjęciu systemu oceny zaawansowania raka błony śluzowej trzonu macicy z uwzględnieniem usunięcia węzłów chłonnych okołoaortalnych i miedniczych. Jednak zakres optymalnego zabiegu limfadenektomii oraz identyfikacja pacjentek mogących odnieść korzyści z takiego postępowania wciąż są przedmiotem dyskusji. Celem badania była ocena częstości występowania i dystrybucji przerzutów do węzłów chłonnych miedniczych i aortalnych u pacjentek z rakiem błony śluzowej trzonu macicy oraz analiza czynników kliniczno-patologicznych mogących predysponować do ich powstania, a także ich roli w ustalaniu zakresu limfadenektomii. Metody: Retrospektywne badanie przeprowadzono wśród pacjentek z rakiem endometrium przyjętych na Oddział Ginekologii i Położnictwa Szpitala Uniwersyteckiego Shinshu w Japonii i Instytutu Leczenia Nowotworów w Południowym Egipcie Uniwersytetu w Assiut w Egipcie w okresie od czerwca 2005 do maja 2014 roku. W badanym okresie węzły chłonne miednicze i okołoaortalne usunięto u wszystkich chorych w ramach pierwotnego leczenia. Dane demograficzne i kliniczno-patologiczne zebrano i oceniono w oparciu o występowanie przerzutów w węzłach chłonnych miedniczych i okołoaortalnych. Wyniki: Do badania włączono 78 pacjentek (35 z Japonii i 43 z Egiptu) z rakiem błony śluzowej trzonu macicy w stadium FIGO I–IV z uwzględnieniem wszystkich podtypów histopatologicznych oraz stopni złośliwości histopatologicznej nowotworu. Wykazano istotną korelację między występowaniem przerzutów w węzłach chłonnych miednicy a zaawansowaniem choroby (stopień III i IV), obecnością zmian endometrioidalnych, inwazją miometrium >1/2, zajęciem przydatków i inwazją przestrzeni limfatycznej. Z kolei występowanie przerzutów w węzłach chłonnych okołoaortalnych było istotnie skorelowane z zaawansowaniem choroby (stopień III i IV), inwazją miometrium >1/2, zajęciem przydatków i inwazją przestrzeni limfatycznej. Wnioski: Badanie wykazało, że zakres limfadenektomii u chorych na raka endometrium można dostosować na podstawie stratyfikacji ryzyka wystąpienia przerzutów w węzłach chłonnych. U pacjentek niskiego ryzyka procedurę tę można pominąć w celu uniknięcia powikłań związanych z zabiegiem.

Keywords

EN

endometrial neoplasms; incidence; lymph node excision; lymphadenectomy; retrospective studies

Discipline

• MEDICINE: MEDICINE

• Publisher: Medical Communications
• Journal: Current Gynecologic Oncology
• Year: 2017
• Volume: 15
• Issue: 4
• Pages: 239–245

Contributors

author

Hussein Fakhry

• Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

author

Gamal Amira

• Surgical Oncology Department, National Cancer Institute, Cairo University, Cairo, Egypt

author

Doaa Wadie

• Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

author

Anwar Tawfik Amin

• Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

author

Murad Jabir

• Surgical Oncology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

author

Ikuo Konishi

• Gynecology and Obstetrics Department, Kyoto University, Kyoto, Japan

author

Tanri Shiozawa

• Gynecology and Obstetrics Department, Shinshu University School of Medicine, Matsumoto, Japan

author

Ahmed Sekotory

• Obstetrics and Gynecology Department, The Christie NHS Foundation Trust & University Hospital of South Manchester, UK

author

Tarek M. Elsaba

• Pathology Department, South Egypt Cancer Institute, Assiut University, Assiut, Egypt

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• Document Type: article