The survival impact of adding paraaortic lymphadenectomy to pelvic lymphadenectomy in the obese endometrioid endometrial cancer cases

Year 2020, Volume: 45 Issue: 1, 134 - 140, 31.03.2020

Ghanim Khatib , Mehmet Ali Vardar , Ahmet Baris Güzel , Ümran Küçükgöz Güleç , Sevtap Seyfettinoğlu , Berin Bayat Emine Bağır , Semra Paydaş

https://doi.org/10.17826/cumj.631216

Abstract

Purpose: The aim of this study was to investigate the survival impact of adding paraaortic lymphadenectomy to pelvic lymphadenectomy in the obese low-grade endometrioid endometrial cancer cases.
Materials and Methods: The pathology reports, computer records and archival files of the operated endometrial cancer cases were retrospectively reviewed. During this period, among patients with full data, those who had low-grade endometrioid type and Body Mass Index (BMI) >30 kg/m2 were determined. From these cases, merely those who underwent lymph node dissection were included in this study. Patients were divided into two groups; only pelvic lymphadenectomy and pelvic-paraaortic lymphadenectomy. Groups’ demographic, clinical, surgical, follow-up survival data were analyzed and compared.
Results: 290 patients were designated, among them 207 cases who did not undergo lymph node dissection were excluded and therefore study was conducted with 34 patients in the pelvic lymphadenectomy group and 49 in the pelvic-paraaortic lymphadenectomy group. Clinical, surgical and pathological features of both groups were similar. Five-year disease-free survival rate was 80% and 86.3%, while 5-year overall survival rate was 92.6% and 86.3%, respectively.
Conclusion: In case of lymph node dissection was planned to this particular population of the current study, we think that adding paraaortic lymphadenectomy to the pelvic lymph node dissection, may will not contribute to the survival. 

Keywords

Obesity, endometrial cancer, survival

Obez endometroid endometrial kanserli olgulara pelvik lenfadenektomiye paraaortik lenfadenektomi eklenmesinin sağkalıma etkisi

Abstract

Amaç: Bu çalışmada obez düşük grade endometroid endometrial kanserde pelvik lenfadenektomiye paraaortik lenfadenektomi eklenmesinin sağkalıma olan etkisini araştırmaya amaçlanmıştır.
Gereç ve Yöntem: Opere edilen endometrium kanserlerinin patoloji raporları ve birimin bilgisayar kayıtları ile arşiv dosyaları retrospektif bir şekilde tarandı. Bu süre içerisinde tüm bilgilerine ulaşılabilen hastalardan, Vücut Kitle İndeksi (VKİ) >30 kg/m2 ve endometroid histolojiye sahip olan hastalar tespit edildi. Bu vakalardan sadece lenf nodu diseksiyonu yapılmış olanlar çalışmaya dahil edildi. Hastalar uygulanan lenfadenektomiye göre iki gruba ayrıldı; sadece pelvik lenfadenektomi ve pelvik-paraaortik lenfadenektomi. Grupların demografik, klinik, cerrahi, patolojik, takip ve sağkalım bilgileri analiz edilip karşılaştırıldı.
Bulgular: Çalışmanın kriterlerine uygun 290 hasta tespit edildi, bunlardan lenf nodu diseksiyonu uygulanmayan 207 vaka çıkarıldıktan sonra, çalışma pelvik lenfadenektomi grubunda 34 ve pelvik-paraaortik lenfadenektomi grubunda 49 hasta ile yürütüldü. Genel olarak her iki grubun klinik, cerrahi ve patolojik özellikleri benzerdi. Beş yıllık hastalıksız sağkalım sırasıyla %80 ve %86.3, beş yıllık toplam sağkalım ise, %92.6 ve %86.3 idi.
Sonuç: çalışmaya alınan bu özel hasta grubunda, lenf nodu diseksiyonu planlanması halinde, pelvik lenf nodu diseksiyonuna paraaortik lenfadenektominin eklenmesi sağkalıma katkı sağlamayabileceği düşüncesindeyiz

Keywords

obezite, endometroid endometrium kanseri, sağkalım

References

• [1] Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394-424.[2] Gultekin M, Kucukyildiz I, Karaca MZ, Dundar S, Boztas G. Turan SH, et al. Trends of Gynecological Cancers in Turkey: Toward Europe or Asia? Int J Gynecol Cancer. 2017; 27(8S): S1-S9.[3] Zullo F, Falbo A, Palomba S. Safety of laparoscopy vs laparotomy in the surgical staging of endometrial cancer: a systematic review and metaanalysis of randomized controlled trials. Am J Obstet Gynecol. 2012; 207(2): 94-100.[4] Frost JA, Webster KE, Bryant A, Morrison J. Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev. 2017; 10: CD007585.[5] 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.[6] Rungruang B, Olawaiye AB. Comprehensive surgical staging for endometrial cancer. Rev Obstet Gynecol. 2012; 5(1): 28-34.[7] 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.[8] 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.[9] Obesity: preventing and managing the global epidemic. Report of a WHO consultation. World Health Organ Tech Rep Ser. 2000; 894: i-xii, 1-253.[10] Giugale LE, Di Santo N, Smolkin ME, Havrilesky LJ, Modesitt SC. Beyond mere obesity: effect of increasing obesity classifications on hysterectomy outcomes for uterine cancer/hyperplasia. Gynecol Oncol. 2012; 127(2): 326-31.[11] Gunderson CC, Java J, Moore KN, Walker JL. The impact of obesity on surgical staging, complications, and survival with uterine cancer: a Gynecologic Oncology Group LAP2 ancillary data study. Gynecol Oncol. 2014; 133(1): 23-7.[12] 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.[13] Pavelka JC, Ben-Shachar I, Fowler JM, Ramirez NC, Copeland LJ, Eaton LA, et al. Morbid obesity and endometrial cancer: surgical, clinical, and pathologic outcomes in surgically managed patients. Gynecol Oncol. 2004; 95(3): 588-92.[14] Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, 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(23): 1707-16.[15] group As, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009; 373(9658): 125-36.[16] 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.