Para-aortic ganglionic involvement in early stages of endometrial cancer according to the algorithm of Kumay et al.
Compromiso ganglionar para-aórtico en estadios tempranos de cáncer de endometrio de acuerdo con el algoritmo de kumay y col.
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Puentes, L. O., Rojas, C. A., Mora, E., & Mendoza, J. (2018). Para-aortic ganglionic involvement in early stages of endometrial cancer according to the algorithm of Kumay et al. Journal of Medicine and Surgery Repertoire, 27(2). https://doi.org/10.31260/RepertMedCir.v27.n2.2018.176
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Abstract
Introduction: Controversy persists on the benefit of para-aortic lymphadenectomy in patients with early-stage endometrial cancer, for some trials suggest increased morbidity and costs showing no clear benefit for overall survival. Objective: to determine para-aortic lymph node metastases (LNM) in patients with early-stage endometrial cancer according to the Kumar et al. risk classification algorithm. Method: a case series descriptive retrospective study was conducted in patients who underwent open or laparoscopic staging surgical procedures (total hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy), diagnosed with endometrioid endometrial adenocarcinoma, classified by the risk algorithm and analysis of their outcomes. Results: a total of 15 patients were included, of the 9 patients classified as high risk by the Kumar et al algorithm, 2 (28.5%) had para-aortic LNM, and no patients in the low risk group had LNM. Four (26.6%) patients had postoperative complications, 75% were early complications, one patient was admitted to the intensive care unit (ICU) and there were no deaths related to the surgical procedures. Conclusion: low risk patients classified by the Kumar et al algorithm had no para-aortic LNM however high risk patients had different results. We cannot therefore recommend routine para-aortic lymphadenectomy. Further prospective clinical trials must be conducted for validation of this algorithm with the same number of patients with which it was proposed.
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References
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11. De Wilde RL, Rafei A, Herrmann A. Can a lymphadenectomy be avoided in early-stage endometrial adenocarcinoma? Arch Gynecol Obstet. 2014;290(5):973-8.
12. Solmaz U, Mat E, Dereli M, Turan V, Gungorduk K, Hasdemir P, et al. Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol. 2015;55(1):81-6.
13. Hahn HS, Lee IH, Kim TJ, Lee KH, Shim JU, Kim JW, et al. Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer. Aust N Z J Obstet Gynaecol. 2013;53(3):293-7.
14. Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek JS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol. 2007;109(3):655-62.
15. Benedetti Panici P, Basile S, Salerno MG, Di Donato V, Marchetti C, Perniola G, et al. Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma. Am J Obstet Gynecol. 2014;210(4):363.e1-.e10.
16. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035-41.
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18. Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer. 1991;67(11):2791-4.
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20. Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005;106(4):693-9.
21. Todo Y, Takeshita S, Okamoto K, Yamashiro K, Kato H. Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis. J Gynecol Oncol. 2017;28(5):e59.
22. Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014;134(2):385-92.
23. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Kumar S, Weaver AL, McGree ME, et al. Factors predictive of postoperative morbidity and cost in patients with endometrial cancer. Obstet Gynecol. 2012;120(6):1419-27.
24. Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, et al. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130(3):441-5.
25. Fagotti A, Fanfani F, Ercoli A, Giordano MA, Sallustio G, Scambia G. Postoperative ileus after para-aortic lymphadenectomy: a prospective study. Gynecol Oncol. 2007;104(1):46-51.
26. Imai K, Kato H, Katayama K, Nakanishi K, Kawano A, Iura A, et al. A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy. Gynecol Oncol. 2016;142(2):273-7.
27. Kang S, Lee JM, Lee JK, Kim JW, Cho CH, Kim SM, et al. A Web-based nomogram predicting para-aortic nodal metastasis in incompletely staged patients with endometrial cancer: a Korean Multicenter Study. Int J Gynecol Cancer. 2014;24(3):513-9.
28. Sari ME, Yalcin İ, Sahin H, Meydanli MM, Gungor T. Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 2017.
29. Turan T, Hizli D, Sarici S, Boran N, Gundogdu B, Karadag B, et al. Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? Eur J Obstet Gynecol Reprod Biol. 2011;158(2):274-9.
30. Numanoglu C, Corbacioglu Esmer A, Ulker V, Goksedef BP, Han A, Akbayir O, et al. The prediction of para-aortic lymph node metastasis in endometrioid adenocarcinoma of endometrium. J Obstet Gynaecol. 2014;34(2):177-81.
31. Karube Y, Fujimoto T, Takahashi O, Nanjyo H, Mizunuma H, Yaegashi N, et al. Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer. Gynecol Oncol. 2010;118(2):151-4.
2. Alay I, Turan T, Ureyen I, Karalok A, Tasci T, Ozfuttu A, et al. Lymphadenectomy should be performed up to the renal vein in patients with intermediate-high risk endometrial cancer. Pathol Oncol Res. 2015;21(3):803-10.
3. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO, et al. Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol. 2008;109(1):11-8.
4. National comprehensive cancer network (NCCN). NCCN Clinical Practice Guidelines in Oncology. Uterine neoplasms Version 1.2018. National comprehensive cancer network (NCCN); 2018.
5. Zhang H, Zuo Z, Wang Y, Wang L, Zhu Z. A cohort study evaluating paraaortic lymphadenectomy in endometrial cancer. Oncol Lett. 2012;4(6):1361-5.
6. Convery PA, Cantrell LA, Di Santo N, Broadwater G, Modesitt SC, Secord AA, et al. Retrospective review of an intraoperative algorithm to predict lymph node metastasis in low-grade endometrial adenocarcinoma. Gynecol Oncol. 2011;123(1):65-70.
7. Yoon JH, Yoo SC, Kim WY, Chang SJ, Chang KH, Ryu HS. Para-aortic lymphadenectomy in the management of preoperative grade 1 endometrial cancer confined to the uterine corpus. Ann Surg Oncol. 2010;17(12):3234-40.
8. Konno Y, Todo Y, Minobe S, Kato H, Okamoto K, Sudo S, et al. A retrospective analysis of postoperative complications with or without para-aortic lymphadenectomy in endometrial cancer. Int J Gynecol Cancer. 2011;21(2):385-90.
9. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet. 2010;375(9721):1165-72.
10. Bogani G, Dowdy SC, Cliby WA, Ghezzi F, Rossetti D, Mariani A. Role of pelvic and para-aortic lymphadenectomy in endometrial cancer: current evidence. J Obstet Gynaecol Res. 2014;40(2):301-11.
11. De Wilde RL, Rafei A, Herrmann A. Can a lymphadenectomy be avoided in early-stage endometrial adenocarcinoma? Arch Gynecol Obstet. 2014;290(5):973-8.
12. Solmaz U, Mat E, Dereli M, Turan V, Gungorduk K, Hasdemir P, et al. Lymphovascular space invasion and cervical stromal invasion are independent risk factors for nodal metastasis in endometrioid endometrial cancer. Aust N Z J Obstet Gynaecol. 2015;55(1):81-6.
13. Hahn HS, Lee IH, Kim TJ, Lee KH, Shim JU, Kim JW, et al. Lymphovascular space invasion is highly associated with lymph node metastasis and recurrence in endometrial cancer. Aust N Z J Obstet Gynaecol. 2013;53(3):293-7.
14. Lee NK, Cheung MK, Shin JY, Husain A, Teng NN, Berek JS, et al. Prognostic factors for uterine cancer in reproductive-aged women. Obstet Gynecol. 2007;109(3):655-62.
15. Benedetti Panici P, Basile S, Salerno MG, Di Donato V, Marchetti C, Perniola G, et al. Secondary analyses from a randomized clinical trial: age as the key prognostic factor in endometrial carcinoma. Am J Obstet Gynecol. 2014;210(4):363.e1-.e10.
16. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group Study. Cancer. 1987;60(8 Suppl):2035-41.
17. Han KH, Kim HS, Lee M, Chung HH, Song YS. Prognostic factors for tumor recurrence in endometrioid endometrial cancer stages IA and IB. Medicine (Baltimore). 2017;96(21):e6976.
18. Schink JC, Rademaker AW, Miller DS, Lurain JR. Tumor size in endometrial cancer. Cancer. 1991;67(11):2791-4.
19. Canlorbe G, Bendifallah S, Laas E, Raimond E, Graesslin O, Hudry D, et al. Tumor Size, an Additional Prognostic Factor to Include in Low-Risk Endometrial Cancer: Results of a French Multicenter Study. Ann Surg Oncol. 2016;23(1):171-7.
20. Walsh C, Holschneider C, Hoang Y, Tieu K, Karlan B, Cass I. Coexisting ovarian malignancy in young women with endometrial cancer. Obstet Gynecol. 2005;106(4):693-9.
21. Todo Y, Takeshita S, Okamoto K, Yamashiro K, Kato H. Implications of para-aortic lymph node metastasis in patients with endometrial cancer without pelvic lymph node metastasis. J Gynecol Oncol. 2017;28(5):e59.
22. Burke WM, Orr J, Leitao M, Salom E, Gehrig P, Olawaiye AB, et al. Endometrial cancer: a review and current management strategies: part I. Gynecol Oncol. 2014;134(2):385-92.
23. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Kumar S, Weaver AL, McGree ME, et al. Factors predictive of postoperative morbidity and cost in patients with endometrial cancer. Obstet Gynecol. 2012;120(6):1419-27.
24. Kumar S, Mariani A, Bakkum-Gamez JN, Weaver AL, McGree ME, Keeney GL, et al. Risk factors that mitigate the role of paraaortic lymphadenectomy in uterine endometrioid cancer. Gynecol Oncol. 2013;130(3):441-5.
25. Fagotti A, Fanfani F, Ercoli A, Giordano MA, Sallustio G, Scambia G. Postoperative ileus after para-aortic lymphadenectomy: a prospective study. Gynecol Oncol. 2007;104(1):46-51.
26. Imai K, Kato H, Katayama K, Nakanishi K, Kawano A, Iura A, et al. A preoperative risk-scoring system to predict lymph node metastasis in endometrial cancer and stratify patients for lymphadenectomy. Gynecol Oncol. 2016;142(2):273-7.
27. Kang S, Lee JM, Lee JK, Kim JW, Cho CH, Kim SM, et al. A Web-based nomogram predicting para-aortic nodal metastasis in incompletely staged patients with endometrial cancer: a Korean Multicenter Study. Int J Gynecol Cancer. 2014;24(3):513-9.
28. Sari ME, Yalcin İ, Sahin H, Meydanli MM, Gungor T. Risk factors for paraaortic lymph node metastasis in endometrial cancer. Int J Clin Oncol. 2017.
29. Turan T, Hizli D, Sarici S, Boran N, Gundogdu B, Karadag B, et al. Is it possible to predict para-aortic lymph node metastasis in endometrial cancer? Eur J Obstet Gynecol Reprod Biol. 2011;158(2):274-9.
30. Numanoglu C, Corbacioglu Esmer A, Ulker V, Goksedef BP, Han A, Akbayir O, et al. The prediction of para-aortic lymph node metastasis in endometrioid adenocarcinoma of endometrium. J Obstet Gynaecol. 2014;34(2):177-81.
31. Karube Y, Fujimoto T, Takahashi O, Nanjyo H, Mizunuma H, Yaegashi N, et al. Histopathological prognostic factors predicting para-aortic lymph node metastasis in patients with endometrioid uterine cancer. Gynecol Oncol. 2010;118(2):151-4.