The Clinical Significance Of Para-aortic Lymphadenectomy In Patients With Endometrial Carcinoma

Objective:It is still controversial whether para-aortic lymphadenectomy can improve the prognosis of endometrial carcinoma.This study aimed to investigate the effect of para-aortic lymphadenectomy on two-year survival rate and surgical complications and analyze the risk factors affecting the prognosis of patients with endometrial carcinoma with risk factors so as to explore the clinical significance of para-aortic lymphadenectomy in patients with endometrial carcinoma with risk factors.Methods:Information of 194 patients with endometrial carcinoma who were treated to the department of gynaecology of the the First Affiliated Hospital of Dalian Medical University and received surgical treatment from January 2012 to December2016 was collected and analyzed retrospectively.According to the surgical methods,the patients were divided into the group receiving total hysterectomy with bilateral adnexal and pelvic and aortic lymph node resection(referred to as”abdominal sweeping group”,26 cases in total),the group receiving total hysterectomy with bilateral adnexal and pelvic lymph node resection(referred to as”pelvic sweeping group”,110 cases in total),and the group receiving total hysterectomy with bilateral adnexal(referred to as”hysterectomy group”,58 cases in total).Compared the two-year survival rate and the incidence of surgical complications of three groups of patients.SPSS20.0 software was used for statistical analysis of the data.The survival curve was drawn by Kaplan-Meier method and compared by log-rank test.The Chi-Square test was used to analyze whether the incidence of complications in each group was different.The logistic method was used to analyze the independent risk factors affecting the prognosis.The clinical and pathological data of 4 patients with para-aortic lymph node metastasis were retrospectively analyzed to explore the common characteristics of the patients with para-aortic lymph node metastasis.The chi-square test was used to analyze the two-year survival rate of patients with endometrioid adenocarcinoma with stage IA and histological grad 1and 2 who only had the lesion diameter over 2cm and no other risk factors after three surgical methods,so as to explore the reasonable surgical methods for these patients.Refer to the related domestic and foreign literatures.Results:(1)The two-year survival rate of the abdominal sweeping group was92.3%,higher than that of the pelvic sweeping group(90.0%),but the difference between the two groups was not statistically significant(p=0.727).The two-year survival rate of the abdominal and pelvic sweeping groups was significantly higher than that of the hysterectomy group(75.9%),and the difference was statistically significant(p=0.021).(2)There was no statistically significant difference in the incidence of surgical complications among the three surgical methods(p=0.836).(3)The positive rate of lymph nodes was 19.2%in the abdominal sweeping group,13.6%in the pelvic sweeping group,and 5%of the cases of lymph node metastasis were"jumping lymph node metastasis"with only para-aortic lymph node metastasis but no pelvic lymph node metastasis.(4)By the single factor analysis,deep myometrial invasion(?~2=11.972,p=0.01),lymphovascular space invasion(?~2=19.899,p=0.00),lymph node metastasis(?~2=8.731,p=0.003),special pathological type(?~2=7.884,p=0.005),surgical pathological staging(?~2=19.975,p=0.00)are the influence factors of the prognosis of patients with endometrial carcinoma.Multivariate analysis showed that deep muscle infiltration was an independent risk factor for endometrial cancer prognosis(p=0.026).(5)There was no statistically significant difference in the 2-year survival rate of patients with endometrioid adenocarcinoma with stage IA and histological grad 1and 2 who only had the lesion diameter over 2cm and no other risk factors after three surgical treatments(p=0.459).Conclusion:For endometrial cancer patients with risk of lymph node metastasis,lymph node resection can effectively improve the prognosis of patients.Compared with pelvic lymph node resection,para-aortic lymph node resection can not improve the short-term prognosis of patients,but it can increase the positive rate of the lymph nodes,and find the specific type of"jump lymph node metastases",which can effectively guide the prognosis and the follow-up treatment,and not to increase the surgical complications.It's a safe and feasible operation procedure.Prognosis of endometrial cancer is related to multiple factors including deep myometrial invasion,lymphovascular space invasion,lymph node metastasis,special pathological type and surgical pathological stage,among which,deep myometrial invasion is an independent risk factor for two-year survival rate.When many kinds of dangerous factors exist at the same time,it's important to be aware of the risk of lymph node metastases,and para-aortic lymphadenectomy should be actively performed.When there was only the risk factor of lesion diameter over 2cm,but no other risk factors,the patient had a good prognosis,and there was no statistically significant difference in the effect of pelvic and para-aortic lymph node resection on the prognosis,so lymph node resection could be omitted as appropriate.