TITLE:
Isolated Para-Aortic Nodal Recurrence in Endometrial Cancer
AUTHORS:
Motoki Matsuura, Akimasa Takahashi, Hidetaka Nomura, Maki Matoda, Sanshiro Okamoto, Hiroyuki Kanao, Kohei Omatsu, Kazuyoshi Kato, Kuniko Utsugi, Nobuhiro Takeshima
KEYWORDS:
Endometrial Cancer, Recurrence, Isolated Para-Aortic Nodal Recurrence
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.8 No.7,
June
27,
2018
ABSTRACT: Aim: 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.
We investigated the frequency of isolated recurrence in the para-aortic lymph
nodes and the effectiveness of surgery for such recurrence. Methods: A
retrospectively maintained endometrial cancer database at the Cancer Institute
Hospital in Japan was reviewed to identify sites of metastasis and recurrence. Results: 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). Although 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). 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). Conclusions: Patients who underwent dissection of only the pelvic lymph
nodes had a higher frequency of isolated recurrence in the para-aortic lymph
nodes. In addition, a relatively good prognosis could be achieved with surgical
treatment for isolated recurrence in the para-aortic lymph nodes, which was
better than that achieved using non-surgical methods.