ABSTRACT
Introduction: There is no consensus on the extent of lymphadenectomy and the appropriate patients for lymphadenectomy in low-risk patients with endometrial cancer. This study aimed to evaluate the feasibility and effectiveness of laparoscopic lymphadenectomy for low-risk patients with endometrial cancer. Materials and Methods: From January 2004 to May 2008, we reviewed the medical records of 28 patients with low-risk, endometrial cancer; endometrioid type, grade 1 or 2, and with a depth of myometrial invasion of less than one-half of the myometrium. All patients underwent laparoscopically-assisted staging surgery. Results: The median age and body mass index were 56 years (range, 28 to 75) and 25.5 kg/m2 (range, 21.3 to 37.2). The median operating time, estimated blood loss, and length of hospital stay were 142 minutes (range, 110 to 410), 215 mL (range, 100 to 700), and 7 days (range, 3 to 19), respectively. No conversion to laparotomy was noted. The median number of harvested lymph nodes was 21 (range, 10 to 48) pelvic nodes and 12 (range, 4 to 21) para-aortic nodes. One (3.6%) patient presented pelvic lymph node metastasis and 2 (7.1%) presented isolated para-aortic lymph node metastasis. The complication rate was 14.3%. No recurrence in the vaginal vault, distant metastasis, port site metastasis was noted up to the last follow-up. Conclusion: Systemic pelvic and para-aortic lymphadenectomy should be considered in all low-risk patients with endometrial cancer until it is concluded to be clinically insignifi cant through large-scale prospective research in the future. However, it will be diffi cult to explain statistical differences in survival rates according to lymphadenectomy, because the increase of the survival rate resulting from lymphadenectomy will fall within the margin of statistical error
Endometrial cancer is the third most frequent gynaecologic cancer in Korea, following cervical cancer and ovarian cancer. With the increasingly Westernised lifestyles of Korean women – including exposure to oestrogen hormones, the number of pregnancies, the age of menarche and the age of menopause – the number of reported endometrial cancers has rapidly increased, up from 132 in 1991 when the gynaecological cancer registration programme was started, to 862 in 2004, a 6-fold increase.1 Because of this rapid increase in the incidence of endometrial cancer, there is increasing concern over and research on endometrial cancer in Korean women.2
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