Lymph node mapping and involvement in endometrial cancer

Objectives: The aim of this study was to evaluate the outcome of pelvic and/or para-aortic lymph node dissection in patients with endometrial cancer with regard to lymph node positivity. Materials and Methods: Retrospective chart review of 125 women with pathologically proven endometrial carcinoma who underwent a systematic surgical staging including lymphadenectomy between January 2006 and January 2011 was performed. Patients' characteristics, histological findings, lymph node localization and involvement were analyzed. Detailed description of the extirpated and affected lymph nodes divided by area in the 125 patients with endometrial cancer were done. Results: The medical records for 125 patients were eligible for analysis. The mean number of all lymph nodes removed in operation was 38.9±14.194 (range 9 to 81 nodes). The mean number of pelvic lymph nodes (PLN) removed was 32±11.747 (range 9 to 75 nodes) and the mean number of para-aortic lymph nodes (PALN) removed was 7±5.123 (range 0 to 20 nodes). In the 24 patients with nodal metastasis, the mean number of all lymph nodes removed was 37.88±17.501 (range 9 to 81 nodes). The mean number of PLNs removed was 30.71±14.79 (range 9 to 66 nodes) and the mean number of PALNs removed was 7.17±4.198 (range 0 to 16 nodes). Nodal metastasis was shown in 24 (19.2%) patients. Isolated pelvic lymph node metastasis was shown in nine (37%) patients; isolated para-aortic lymph node metastasis was shown in one (4%) patient; both pelvic and para-aortic lymph node metastasis was shown in 14 (59%) patients. The most affected lymph node area was left external iliac artery with a ratio of 14%. Conclusions: In the field of gynecologic cancer surgery, for the determination of adequate number of lymph nodes to be retrieved, lymph node mapping plays a crucial role, and this issue should be investigated in studies performed with larger number of cases in order to standardize procedure of lymphadenectomy.