4 lymphadenectomy in 63 patients with stage IIIC endometrial carcinoma. Despite there was no signiﬁcant diﬀerence in disease-related survival, the authors found an improvement in disease-related survival in patients with two or more positive lymph nodes [57]. Mariani et al. reported the potential therapeutic role of paraaortic lymphadenectomy in node positive patient with endometrial cancer [58, 59]. The 5-year progression free and overall survival rates were signiﬁcantly better in paraaortic lymphadenectomy group. From the available studies we could conclude that paraaortic lymphadenectomy might have a therapeutic role at least for high-risk patients. However, further RCT are needed to conﬁrm this conclusion. 5.2. Cranial Limit of Paraaortic Lymphadenectomy: Where to Arrive? Moreover, the cranial extent of paraaortic lym- phadenectomy has recently been a matter of debate. A prospective study by Mariani et al. evaluated patients with high-risk endometrial cancer requiring a complete lymphadenectomy. Considering patients with positive lymph nodes, 77% of them had paraaortic metastasis above the IMA. The authors emphasized the importance of systematic pelvic and paraaortic lymphadenectomy up to the renal vessels with excision of the gonadal veins [20]. 5.3. Number of Removed Lymph Nodes. Another controver- sial issue is the number of lymph nodes that must be removed for proper surgical staging. Lutman et al. found that pelvic lymph node count ≥12 is an independent prognostic factor for both overall and progression-free survival in patients with FIGO stage I and II with high-risk histology [18]. Another study by Cragun et al. conﬁrmed that patients with grade 3 endometrial cancers having more than 11 pelvic nodes removed had improved overall survival and progression-free survival compared with patients with 11 or fewer nodes removed [19]. Chan et al. have shown a correlation between the increasing number of lymph nodes removed and number of nodal metastasis. They concluded that the removal of 21 to 25 nodes was considered to signiﬁcantly increase the probability of detecting at least one lymph node metastasis [60]. 6. Surgical Approach for Staging of Endometrial Cancer Surgical treatment of endometrial cancer has traditionally been through laparotomy. Nevertheless, in the last 15 years, the use of minimally invasive techniques is getting widely accepted by many authors [61–64]. The laparo- scopic approach can be either laparoscopic-assisted vaginal hysterectomy (LAVH) or total laparoscopic hysterectomy (TLH). These procedures proved feasible and safe when compared with laparotomy [61–69]. The primary endpoint for trials comparing laparoscopic and laparotomic approach is to demonstrate the equivalence in terms of staging completeness and survival rates. Other endpoints are hospital stay, postoperative pain, quality of life (QOL), and health costs of the procedures. The randomized Obstetrics and Gynecology International study of the Gynaecologic Oncology Group (GOG-LAP2) considered the laparoscopic and laparotomic surgery for stage I-IIa, grade 1–3 endometrial cancer. There were no sig- niﬁcant diﬀerences in terms of staging completeness, lymph node metastasis, rate of perioperative complications, and mortality between the two procedures. This trial veriﬁed that although the laparoscopic approach has a longer operative time, it has the advantage of a shorter hospital stay [61]. The quality of life is another important index in evaluation of the therapeutic role of laparoscopy in endometrial cancer. The same study (GOG-LAP2), through examination of QOL indicators and from the results of validated questionnaire SF-36, demonstrated that laparoscopy has a signiﬁcant advantage in terms of quality of life within the ﬁrst 6 weeks. Data from GOG-LAP2 on rate of relapse and long-term survival are not yet available [61]. A recent meta-analysis showed that, in early stages, laparoscopic approach is equally eﬀective as laparotomic one in terms of overall survival, disease-free, and cancer- related survival. Both techniques were proven equal in terms of intraoperative complications and number of pelvic and paraaortic node yield. Laparoscopy had additional beneﬁts like lower blood loss and fewer postoperative complications rates; however, it had other disadvantages in terms of longer operative time and learning curve [63]. 6.1. Use of Laparoscopy in Obese Patients with Endometrial Cancer. The feasibility and safety of the use of laparoscopy in obese women with endometrial cancer are other issues of concern. Obesity and comorbidity were considered, for many years, contraindications for laparoscopic approach. However, comparative studies demonstrated that patients with increased surgical risk (obese and elderly) are the ones who most beneﬁt from the minimally invasive approach, in terms of reduction of operative morbidity (e.g., laparotomic wound infections and bowel obstruction), postoperative pain, hospital stay, and time to return to full activity [65–70]. A recent study compared the safety and eﬃcacy of laparoscopy and laparotomy in surgical staging of early stages (FIGO I-II) in obese women. Authors found no signiﬁcant diﬀerences among the two groups regarding mean operative time, with a signiﬁcantly higher blood loss and hospital stay in patients treated by laparotomy [67]. Another study comparing obese and nonobese women with laparoscopically treated stage I endometrial cancer found no diﬀerence in operative time, pelvic node removed, and complications, although obese group had higher blood loss [68]. 6.2. Actual Use of Laparoscopy in Endometrial Cancer Man- agement. Despite the controversies regarding endometrial cancer staging by laparoscopy, the use of this procedure in oncological practice is increasingly rising. A recent follow- up survey among members of the Society of Gynaecolog- ical Oncology found an overall increase in the use and indications for minimally invasive surgery in gynaecological oncology. 91% of responders indicated that they perform