To what extent should para-aortic lymphadenectomy be carried out for surgically staged endometrial cancer?

OBJECTIVE: To investigate the involvement of lymph nodes in para-aortic (PA) region particularly above and below the inferior mesenteric artery (IMA) in patients with endometrial cancer who had complete systemic pelvic and PA lymphadenectomy.

METHODS: A total of 165 consecutive patients with endometrial cancer surgically staged from January 2008 to March 2011 in the gynecologic oncology unit of a tertiary maternity center, Zekai Tahir Burak Hospital, Ankara, Turkey, were included retrospectively. All patients had complete pelvic and PA lymphadenectomy.

RESULTS: Nineteen women had any metastasis in pelvic and/or PA region. Twelve women (7.3%) had only pelvic, 5 women (3%) had both pelvic and PA, and 2 women had isolated PA metastasis. There were 6 patients (3.7%) with PA nodal metastasis above the IMA. Four patients with PA node involvement had positive nodes above the IMA without any metastasis below the IMA. In binary logistic regression analysis, PA metastasis above the IMA was associated with lymphovascular space invasion, pelvic metastasis, and tumor size.

CONCLUSIONS: Isolated PA metastasis is rare in endometrial cancer. If pelvic nodes are involved, PA metastasis is likely, and PA lymphadenectomy should be performed up to renal vessels so as not to miss occult metastasis in higher regions particularly above the IMA.