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The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer

Year 2022, Volume: 39 Issue: 2, 438 - 442, 18.03.2022

Abstract

Objective: This study aimed to find out whether sentinel algorithm can be sufficient in clinically
uterine confined intermediate-high risk endometrial cancer.
Methods: Detailed pathology characteristics and follow-up records of the 70 intermediate-high risk
endometrial cancer patients were identified. Outcomes of patients who are performed sentinel
algorithm and sentinel mapping followed by systematic pelvic and paraaortic lymph node dissection
were compared. All patients who had obvious extrauterine disease in preoperative and
intraoperative evaluation were excluded. Sentinel mapping is performed with methilene blue and
cervical injection.
Results: 66 patients were identified [sentinel algorithm group, 25; Paraaortic lymph node dissection
group, 45]. Paraaortic lymph node dissection group had more high grade patients (p=0,02 ). The
mean number of lymph nodes harvested was 11,3 and 36,9, respectively, in sentinel algorithm group
and paraaortic lymph node dissection group(p<0,001) and there was more lymph node metastasis in
paraaortic lymph node dissection group(12% and 31,7%; p=0,07). 84% in the sentinel algorithm
group and 92,7% in the paraaortic lymph node dissection group, respectively, received adjuvant
therapy (p=0,02). Overall, four patients recurred within the first three year following surgery, two
patients had systematic multiple metastasis and both of them died due to disease. There was no
significant difference between the two groups in terms of overall survival (p = 0.252), disease
specific survival (p = 0.10) and disease free survival (p = 0.577). The mean follow-up period was
calculated as 29.33 months.
Conclusion: To date, there is no prospective study focused on whether sentinel lymphadenectomy
in endometrial cancer is sufficient for management of moderate high-risk endometrial cancer and to
establish the necessity of paraaortic lymphadenectomy in this patient group. Our study indicates that
for clinically uterine confined intermediate-high risk endometrial cancer patients sentinel lymph
node algorithm can be sufficient. Further studies are needed to confirm this finding.

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References

  • 1. 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: 1165–72
  • 2. The writing committee of behalf of the ASTEC study group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009; 373: 125−36.
  • 3. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170–99.
  • 4. Colombo N, Creutzberg C, Amant F, Bosse T, Martin AG, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015;117:mdv484.
  • 5. Benedetti Panici P, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. J Natl Cancer Inst 2008;100:1707–16.
  • 6. Zahl Eriksson AG, Ducie J, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparisonof a sentinel lymph node and selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. Gynecol Oncol 2016;140:394–9.
  • 7. Papadia A, Gasparri ML, Siegenthaler F, Imboden S, Mohr S, Mueller MD. FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem? J Cancer Res Clin Oncol 2017;143:491–7.
  • 8. Schlappea BA, Weaverb AL, Duciea JA, Eriksson AGZ, Dowdy SC, Cliby WA, et al. a Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: a sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol Oncol 2018 November ; 151(2): 235–242
  • 9. 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 109 (2008) 11–18.
  • 10. Karalok A, Turan T, Basaran D, Turkmen O, Kimyon GC, Tulunay G, et al. Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer Overtreatment Is the Main Issue. Int J Gynecol Cancer 2017;00: 00Y00
  • 11. Mariani A, Webb MJ, Galli L, Podratz GC. Potential Therapeutic Role of Para-aortic Lymphadenectomy in Node-Positive Endometrial Cancer. Gynecol Oncol 2000;76:348–56.
  • 12. Kumar S, Podratz KC, Bakkum-Gamez JN, Dowdy SC, Weaver AL, McGree ME, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrialcancer. Gynecol Oncol 2014;132:38–43.
  • 13. Nasioudis D, Holcomb K, Incidence of isolated para-aortic lymph node metastasis in early stage endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2019 Nov;242:43-46
  • 14. Ruiz R, Gorostidi M, Jaunarena I, Goiri C, Aguerre J, Lekuona A. Sentinel Node Biopsy in Endometrial Cancer With Dual Cervical and Fundal Indocyanine Green Injection. Int J Gynecol Cancer 2018 Jan;28(1):139-144
  • 15. Fotopoulou C, El-Balat A, du Bois A, Sehouli J, Harter P, Muallem MZ, et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer Arch Gynecol Obstet. doi:10.1007/s00404-015-3746-6
Year 2022, Volume: 39 Issue: 2, 438 - 442, 18.03.2022

Abstract

Project Number

-

References

  • 1. 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: 1165–72
  • 2. The writing committee of behalf of the ASTEC study group. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 2009; 373: 125−36.
  • 3. Koh WJ, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2018;16:170–99.
  • 4. Colombo N, Creutzberg C, Amant F, Bosse T, Martin AG, Ledermann J, et al. ESMO-ESGO-ESTRO Consensus Conference on Endometrial Cancer: diagnosis, treatment and follow-up. Ann Oncol 2015;117:mdv484.
  • 5. Benedetti Panici P, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G, et al. Systematic Pelvic Lymphadenectomy vs No Lymphadenectomy in Early-Stage Endometrial Carcinoma: Randomized Clinical Trial. J Natl Cancer Inst 2008;100:1707–16.
  • 6. Zahl Eriksson AG, Ducie J, Ali N, McGree ME, Weaver AL, Bogani G, et al. Comparisonof a sentinel lymph node and selective lymphadenectomy algorithm in patients with endometrioid endometrial carcinoma and limited myometrial invasion. Gynecol Oncol 2016;140:394–9.
  • 7. Papadia A, Gasparri ML, Siegenthaler F, Imboden S, Mohr S, Mueller MD. FIGO stage IIIC endometrial cancer identification among patients with complex atypical hyperplasia, grade 1 and 2 endometrioid endometrial cancer: laparoscopic indocyanine green sentinel lymph node mapping versus frozen section of the uterus, why get around the problem? J Cancer Res Clin Oncol 2017;143:491–7.
  • 8. Schlappea BA, Weaverb AL, Duciea JA, Eriksson AGZ, Dowdy SC, Cliby WA, et al. a Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: a sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol Oncol 2018 November ; 151(2): 235–242
  • 9. 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 109 (2008) 11–18.
  • 10. Karalok A, Turan T, Basaran D, Turkmen O, Kimyon GC, Tulunay G, et al. Lymph Node Metastasis in Patients With Endometrioid Endometrial Cancer Overtreatment Is the Main Issue. Int J Gynecol Cancer 2017;00: 00Y00
  • 11. Mariani A, Webb MJ, Galli L, Podratz GC. Potential Therapeutic Role of Para-aortic Lymphadenectomy in Node-Positive Endometrial Cancer. Gynecol Oncol 2000;76:348–56.
  • 12. Kumar S, Podratz KC, Bakkum-Gamez JN, Dowdy SC, Weaver AL, McGree ME, et al. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrialcancer. Gynecol Oncol 2014;132:38–43.
  • 13. Nasioudis D, Holcomb K, Incidence of isolated para-aortic lymph node metastasis in early stage endometrial cancer. Eur J Obstet Gynecol Reprod Biol. 2019 Nov;242:43-46
  • 14. Ruiz R, Gorostidi M, Jaunarena I, Goiri C, Aguerre J, Lekuona A. Sentinel Node Biopsy in Endometrial Cancer With Dual Cervical and Fundal Indocyanine Green Injection. Int J Gynecol Cancer 2018 Jan;28(1):139-144
  • 15. Fotopoulou C, El-Balat A, du Bois A, Sehouli J, Harter P, Muallem MZ, et al. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer Arch Gynecol Obstet. doi:10.1007/s00404-015-3746-6
There are 15 citations in total.

Details

Primary Language English
Subjects Health Care Administration
Journal Section Clinical Research
Authors

Nedim Tokgozoglu This is me 0000-0002-5727-864X

Orhan Sahın 0000-0002-7216-3816

Tolga Taşçı 0000-0001-8645-4385

Nur Dokuzeylül Güngör 0000-0002-7234-3876

Project Number -
Early Pub Date March 18, 2022
Publication Date March 18, 2022
Submission Date October 18, 2021
Acceptance Date November 16, 2021
Published in Issue Year 2022 Volume: 39 Issue: 2

Cite

APA Tokgozoglu, N., Sahın, O., Taşçı, T., Dokuzeylül Güngör, N. (2022). The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer. Journal of Experimental and Clinical Medicine, 39(2), 438-442.
AMA Tokgozoglu N, Sahın O, Taşçı T, Dokuzeylül Güngör N. The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer. J. Exp. Clin. Med. March 2022;39(2):438-442.
Chicago Tokgozoglu, Nedim, Orhan Sahın, Tolga Taşçı, and Nur Dokuzeylül Güngör. “The Role of Paraaortic Lymphadenectomy Along With Sentinel Mapping in Clinically Uterine Confined Intermediate-High Risk Endometrial Cancer”. Journal of Experimental and Clinical Medicine 39, no. 2 (March 2022): 438-42.
EndNote Tokgozoglu N, Sahın O, Taşçı T, Dokuzeylül Güngör N (March 1, 2022) The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer. Journal of Experimental and Clinical Medicine 39 2 438–442.
IEEE N. Tokgozoglu, O. Sahın, T. Taşçı, and N. Dokuzeylül Güngör, “The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer”, J. Exp. Clin. Med., vol. 39, no. 2, pp. 438–442, 2022.
ISNAD Tokgozoglu, Nedim et al. “The Role of Paraaortic Lymphadenectomy Along With Sentinel Mapping in Clinically Uterine Confined Intermediate-High Risk Endometrial Cancer”. Journal of Experimental and Clinical Medicine 39/2 (March 2022), 438-442.
JAMA Tokgozoglu N, Sahın O, Taşçı T, Dokuzeylül Güngör N. The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer. J. Exp. Clin. Med. 2022;39:438–442.
MLA Tokgozoglu, Nedim et al. “The Role of Paraaortic Lymphadenectomy Along With Sentinel Mapping in Clinically Uterine Confined Intermediate-High Risk Endometrial Cancer”. Journal of Experimental and Clinical Medicine, vol. 39, no. 2, 2022, pp. 438-42.
Vancouver Tokgozoglu N, Sahın O, Taşçı T, Dokuzeylül Güngör N. The role of paraaortic lymphadenectomy along with sentinel mapping in clinically uterine confined intermediate-high risk endometrial cancer. J. Exp. Clin. Med. 2022;39(2):438-42.