| ObjectiveTo investigate the effect of para-aortic lymph node dissection on the prognosis of endometrial carcinoma,and to further clarify the risk factors of retroperitoneal lymph node metastasis and the influence of lymph node metastasis on the prognosis of patients with endometrial carcinoma.Methods:210 patients with endometrial carcinoma who were treated in our hospital from April 2010 to January 2015 were selected as the study subjects.The clinical data were retrospectively analyzed.According to the extent of retroperitoneal lymph node dissection,all patients were divided into the pelvic group(78 cases underwent simple pelvic lymphadenectomy)and the pelvic and abdominal aorta group(132 cases underwent pelvic and para-aortic lymph node dissection was performed).The operation time,intraoperative bleeding,postoperative drainage volume,lymph node dissection volume and positive number,recovery time,postoperative complications,recurrence and metastasis,survival of the two groups were compared,and the clinical and pathological data were collected for influencing the occurrence of retroperitoneal lymph node metastasis and influencing the patient’s prognosis.the clinical and pathological data were collected.The factors influencing retroperitoneal lymph node metastasis and prognosis were analyzed statistically.Chi-square test or exact probability method were used to analyze the single factor.Logistic regression model was used to analyze the multiple factors,P<0.05 indicates that the difference is statistically significant.Results(1)The operation time of pelvic and abdominal aorta group was significantly longer than that of pelvic group(P<0.05).There were no significant differences in blood volume,postoperative drainage,postoperative recovery time(anal exhaust time,bladder function recovery time),postoperative indwelling time of urethra and hospitalization time between the two groups(P>0.05).The average number of lymph node dissection and the number of positive lymph nodes in the pelvic and abdominal aortic group were significantly higher than those in pelvic group(P<0.05).(2)The main complications during the operation were bladder injury,large vessel injury and ureter injury.The main postoperative complications were fever,abdominal incision healing,urinary retention,lymphocyst and ureteral fistula.There was no significant difference in the incidence of complications between the two groups(P>0.05).(3)The 3 year survival rate of pelvic cavity group was 90.7%,the 3 year survival rate was 81.3%%,and the recurrence rate was 18.7%.In pelvic and abdominal aorta group,the 3-year survival rate was 96.7%,the 3-year tumor-free survival rate was 93.8%,and the recurrence rate was 6.3%.There was no significant difference in 3-year survival rate and 3-year tumor-free survival rate between the two groups(P>0.05).There was significant difference in the recurrence rate between the two groups(P<0.05).(4)Univariate analysis showed that pathological type,pathological grade,depth of myometrial invasion,cervical interstitial involvement,peritoneal lavage cytology,vaginal or parametrial involvement and adnexal metastasis were the influencing factors of lymph node metastasis(P<0.05).Multivariate analysis showed that pathological grade and depth of myometrial invasion were independent influencing factors of lymph node metastasis(P<0.05).Further univariate and multivariate analysis showed that pathological grade,depth of myometrial invasion,adnexal metastasis and pelvic lymph node metastasis were the independent influencing factors of para-aortic lymph node metastasis(P<0.05).(5)Univariate analysis showed that pathological grade,pathological type,surgical-pathological stage,adnexal metastasis,myometrial invasion,positive ascites cytology,pelvic lymph node metastasis,para-aortic lymph node metastasis,and extent of lymph node dissection were the prognostic factors of endometrial carcinoma patients(P<0.05).The results showed that myometrial invasion,pathological grade,pelvic lymph node metastasis,abdominal main lymph node metastasis,adnexal metastasis and lymph node dissection were independent prognostic factors for endometrial carcinoma(P<0.05).Conclusion(1)Compared with pelvic lymphadenectomy alone,although the operation time of the pelvic lymphadenectomy and para-aortic lymphadenectomy has been prolonged,it can increase the number of lymph nodes removed and reduce the recurrence and metastasis rate of patients with endometrial carcinoma,and it does not increase the incidence of surgical complications.In addition,pelvic and para-aortic lymphadenectomy can help patients to carry out accurate surgical-pathological staging,provide more scientific basis for postoperative adjuvant treatment,is a safe,effective and feasible surgical program.(2)Pathological grading,depth of myometrial invasion,adnexal metastasis and pelvic lymph node metastasis are independent influencing factors of para-abdominal aortic lymph node metastasis,which can guide clinical para-aortic lymph node dissection.Patients with pelvic lymph node metastasis and para-aortic lymph node metastasis have poor prognosis.Therefore,patients with lymph node metastasis should actively take postoperative adjuvant treatment to reduce the recurrence rate and improve the prognosis. |
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