Lymphadenectomy may be unnecessary for some endometrial cancer patients

Para-aortic lymphadenectomy may be unnecessary in endometrial carcinoma patients without risk factors for para-aortic lymph node metastasis, according to the results of a study published in the May issue of the American Journal of Obstetrics and Gynecology.

Dr. Noriaki Sakuragi and colleagues from the Hokkaido University School of Medicine, in Japan, examined the predictive value of the preoperative examination for retroperitoneal lymph node metastasis in 214 patients with endometrial carcinoma.Preoperative evaluations included MRI-assessed volume index, depth of myometrial invasion, serum CA 125 level, and histological type and grade. The researchers determined cut-off values of volume index and serum CA 125 levels and examined the relationship between these and pelvic lymph node metastasis. They also studied the relationship between these measures and para-aortic lymph node metastasis.The investigators report that histological type and grade, volume index, and serum CA 125 level were independent risk factors for pelvic lymph node metastasis. Serum CA 125 level and volume index were independent risk factors for para-aortic lymph node metastasis.Of 110 patients with no risk factors for pelvic lymph node metastasis, 4 (3.6%) had pelvic lymph node metastasis. Of 128 patients with no risk factors for para-aortic lymph node metastasis, only 1 (0.7%) had metaplasia.”Careful consideration of possibility of the elimination of the requirement of retroperitoneal lymphadenectomy is needed in cases with no risk factors for lymph nodes metastasis,” they write. However, they suggest that it may be possible to stratify endometrial cancer patients preoperatively by risk factors, identifying those who may not require lymphadenectomy.(Source: Am J Obstet Gynecol 2003;188:1265-1272: Reuters Health: May 28, 2003: Oncolink)