Prognostic Value Of Pelvic Lymphadenectomy In Patients With Endometrial Carcinoma

Objective:Systematic review of the safety and effectiveness of lymphadenectomy in the treatment of endometrial cancer. Methods: PubMed, Embase, the Cochrane Library, and the China National Knowledge Infrastructure database were systematically searched using the following search terms: ’lymphadenectomy’,’lymph nodes dissection’,’endometrial cancer’,’endometrial carcinoma’. There was included systematic lymphadenectomy (SL) and unsystematic lymphadenectomy (USL). There were two criteria to identify systematic versus unsystematic lymphadenectomy:removal of ≥10-12 versus ≤10-11 lymph nodes; systematic dissection of lymphatic tissues versus not performed lymph nodes dissection. Meta-analysis was performed using RevMan 5.2 software. Results:Thirteen studies were identified including two randomized controlled trials (RCTs) and 11 non-randomized controlled trials (non-RCTs). SL was associated with much higher overall survival (OS),disease-free survival than USL,HR=0.75,95%CI (0.56,1.0), P=0.03; HR=0.67,95%CI (0.47, 0.95),P=0.03. Data from these trials indicated a trend that removal of ≥10-12 lymph nodes was associated with better OS than removal of ≤10-11, HR=0.69,95%CI(0.52,0.91), P=0.009, whereas its efficacy was not shown in overall survival between systematic dissection of lymphatic tissues and no lymphadenectomy, HR=0.79,95%CI (0.50,1.25),P=0.32. SL showed significantly higher OS rates than for the USL procedure in patients with intermediate-or high risk disease, while OS rates were similar in low risk disease. The complications of lymphocytes and lymphedema in SL were higher occurred than USL, there was significant difference(OR=8.97,95%CI (4.04,19.89),P<0.00001. Conclusion: Systematic lymphadenectomy (≥10-12 lymph nodes dissection) leads to higher OS than unsystematic lymphadenectomy in patients with intermediate- or high-risk endometrial cancer. lymphadenectomy improved surgical staging and showed clinical benefit in interment.Objective:The purpose of this research was to investigate the prognostic value of pelvic lymphadenectomy in patient with endometrial cancer. Methods:All patients who were treated surgically for endometrial cancer from August 2006 to December 2013 were analyzed. Survival analysis was performed in patients with or without pelvic lymphadenectomy by using Kaplane-Meier and Cox proportional hazards methods. Results:112 cases underwent pelvic lymphadenectomy and 127 did not. Menopause, lymphovascular space invasion and Lymph nodes metastatic were independent prognostic factors. The 1,3,5 and 8 years survival rate in patients who underwent pelvic lymphadenectomy were 99.1%、94.0%、88.8% and 48.9%, respectively, and in those without pelvic lymphadenectomy were 96.8%、93.8%.89.0% and 57.6% (P=0.800). Patients having more than 11 pelvic nodes removed had improved overall survival compared with patients having with 11 or fewer, but it is not statistical significance (P=0.084). The overall survival rate was lower in patients with lymph node metastasis (21.8%) than that without lymph node metastasis (61.5%, P<0.05). There was no significant difference in recurrence rate in patients with and without pelvic lymphadenectomy (P>0.05). There was less operation complications in patients without pelvic lymphadenectomy (P<0.05). Conclusion:Patients with pelvic lymphadenectomy had not obviously improved overall survival. The prognosis in patients with pelvic lymph node metastasis is poor. Pelvic lymphadenectomy in patients with endometrial cancer can help to assess the status of lymph nodes, and formulate adjuvant therapy after surgery.