Endometrial cancer is cancer of the endometrium, which is the lining of
the uterus. It is the most common type of cancer that affects the female
reproductive organs. It is the result of the abnormal growth of cells that have
the ability to invade or spread to other parts of the body. And most endometrial
cancer cannot be prevented, but it is often detected at an early stage. It
is usually treated through surgery. While cytoreductive surgery
should be considered for patients with regional recurrence of endometrial
cancer, the management of isolated para-aortic lymph node recurrence remains
controversial. In this study, the authors investigated the frequency of
isolated recurrence in the para-aortic lymph nodes and the effectiveness of
surgery for such recurrence.
A
retrospectively maintained endometrial cancer database at the Cancer Institute
Hospital in Japan was reviewed to identify sites of metastasis and recurrence.
A total of 2322 patients with endometrial cancer underwent primary
treatment with systemic lymphadenectomy between 1984 and 2015. Systematic
pelvic and para-aortic lymph node dissection was performed in 889 patients
(Group 1), while 1433 patients underwent dissection of only the pelvic lymph
nodes (Group 2).
The
results demonstrated that 16 patients (1.1%) in Group 2 had isolated
para-aortic recurrences, only 3 patients (0.3%) in Group 1 had documented
recurrences in the para-aortic lymph nodes (p = 0.043).
The mean time to isolated para-aortic
recurrence was 13 months (3 - 38 months). The
most frequent site of para-aortic node recurrence (36.8%) was on the left side
of the aorta between the level of the inferior mesenteric artery (IMA) and left
renal vein. Although second recurrence occurred in 30.0% of patients who
underwent surgical recurrence treatment, second recurrence occurred in 77.8% of
patients who underwent non-surgical recurrence treatment (p = 0.037). In
addition, the overall survival rate for patients who underwent surgical
recurrence treatment (80.0%) was significantly higher than that for patients
who underwent non-surgical recurrence treatment (33.3%) (p = 0.026).
In
conclusion, the present study revealed that the frequency of isolated
recurrence in the para-aortic lymph nodes was significantly higher in patients
who underwent dissection of only the pelvic lymph nodes compared to those who
underwent pelvic and para-aortic dissection during the initial surgery. When the recurrence site is constrained to the para-aortic lymph
nodes, the prognosis appears to be better with surgical treatment compared to
that with non-surgical methods. Furthermore, the prognosis was relatively good
for patients who underwent surgery for isolated recurrence in the para-aortic
lymph nodes.
Article by Motoki Matsuura, et al, from Cancer Institute
Hospital, Tokyo, Japan.
Full access: http://mrw.so/51Sfbc
Image by National Human Genome Research Institute, from Flickr-cc.
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