Para-aortic lymphadenectomy in endometrial cancer

The retrospective study was over a long period of time during which there have been many changes both in the staging and management of endo metrial cancer. Todo and colleagues do not state whether imaging formed part of their preoperative work-up nor whether the pelvic and para-aortic nodes were known to be involved preoperatively. Currently, MRI is often used for pre-operative staging and patients identifi ed as low risk on the basis of histology and imaging would not under go a staging lymphadenectomy.It would have been informative to know the incidence of pelvic and para-aortic metastasis separately in the intervention group, especially since chemotherapy has been shown to improve survival. Pelvic and para-aortic lymphadenectomy has been shown to be an independent prognostic factor for overall survival; it is, however, important that data for surgical morbidity be included as well. It should also be noted that there was a striking diff erence in the adjuvant treatment policy between the two centres.With the current trend towards minimum access surgery, would Todo and colleagues consider incorporating this into their clinical practice?