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Isolated Para-Aortic Nodal Recurrence in Endometrial Cancer

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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