Clinical Impact Of Lymphadenectomy For Endometrial Cancer In Japan

Introduction/Background Hysterectomy,bilateral salpingectomy, and retroperitoneal lymphadenectomy are often performed as standard surgical procedures for endometrial cancer. However, lymph edema and lymphocele, which are adverse effects of lymphadenectomy, degrade a woman’s quality of life. The therapeutic significance of lymphadenectomy has not been established. This study aimed to clarify the impact of lymphadenectomy on the therapeutic outcome. Methodology The cancer database of Japan Society of Obstetrics and Gynecology provided data on 43,779 patients who started treatment between 2004 and 2011. Among these patients, we retrospectively analyzed the difference in overall survival with and without lymphadenectomy in 36,813 patients who underwent initial surgery and had well registered clinicopathological factors and prognoses. In this study FIGO 1988 staging was used. Results The median age was 58 years, and the median follow-up period was 1610 days. Stage I, II, III and IV were 24,296 (66%), 3,313 (9%), 7,362 (20%) and 1,840 (5%) patients respectively. In terms of histologic type, there were 18,406 (50%), 8,098 (22%), 3,681 (10%), and 5,153 (14%) patients with G1, G2, or G3 endometrioid adenocarcinoma, and non-endometrioid adenocarcinoma, respectively. Seventy-three percent of patients underwent lymphadenectomy. Analysis of each histological type showed that prognosis was significantly better in the lymphadenectomy group than in the non-lymphadenectomy group for each histological type. Analysis at each stage showed that prognosis was significantly better in the lymphadenectomy group than in the non-lymphadenectomy group for each stage, except stage Ia. In the low recurrence-risk group (stage Ia-b, G1-2), there was no significant difference in stage Ia, but in stage Ib. A multivariate analysis revealed that the presence or absence of lymphadenectomy was an independent prognostic factor considering age, stage, histological type, and adjuvant therapy. Conclusion Although there is a limitation that various biases cannot be eliminated because of retrospective study, lymphadenectomy for endometrial cancer may have a prognostic improvement effect. Disclosure Nothing to disclose.