Lymph Node Metastasis in Early Endometrium Cancer
Authors: Ayhan Ali , Yarali Hakan , Urman Bülent , Günalp Serdar , Yüce Kunter , Ayhan Ayse , Havlioglu Samin 
Published: February 2008

EDITORIAL COMMENT: As most readers will know Stage 1 carcinoma of the endometrium is usually treated, in Australia, by total abdominal hysterectomy and bilateral salpingo‐oophorectomy — some oncologists advocate sampling of pelvic and/or paraaortic nodes but none perform routine pelvic and paraaortic total lym‐phadenectomy as presented by the authors of this important series of 106, presumably consecutive, patients. Likewise, the type 2 radical hysterectomy (mobilization of ureters without wide lateral excision of transverse cervical ligaments) is not advocated in this country for clinical Stage I carcinoma of the endometrium. Accordingly readers will be interested to read that lymph node metastases were found in the pelvic nodes from 16 patients (15.1 %) and in the paraaortic nodes from 9 (8.5%) in this series. The authors also provide information showing the correlations between the incidences of nodal metastases and grade and site of the tumour, presence of myometrial invasion, adnexal involvement and histology of the tumour. This paper is not concerned with details of treatment after initial surgery (irradiation to the vaginal vault and/or pelvis, progestogen therapy). The oncologist who reviewed this paper made the point that it is neither easy nor reasonable to perform pelvic and paraaortic node clearances in all patients with Stage 1 carcinoma of the endometrium, many of whom are elderly and/or obese. Although the FIGO recommendation is to use surgical staging for presentation of results of treatment of carcinoma of the endometrium, this cannot be applied until after surgery has been performed, since depth of invasion of the tumour and presence of vascular involvement cannot be judged by examination of the curettings. The authors' statement that pelvic and paraaortic lymphadenectomy has major therapeutic importance in patients with clinical Stage 1 endometrial carcinoma of course cannot be judged from the data in this report. Readers may decide that the information in this paper justifies consideration of lymphadenectomy in some patients with clinical Stage 1 carcinoma of the endometrium. It seems fair to state that the authors' phrase ‘primary surgical staging’ is really synonymous with radical surgical management for all patients with clinical Stage 1 carcinoma of the endometrium.

Summary: The incidences of pelvic and paraaortic lymph node metastases in 106 patients with clinical Stage 1 endometrium cancer are presented. AH patients were primarily surgically staged and treatment consisted of peritoneal cytology assessment, type II radical hysterectomy, bilateral salpingooophorectomy, pelvic and paraaortic total lymphadenectomy. Pelvic lymph node metastases were present in 15.1% and paraaortic lymph node metastases in 8.5% of the patients. Multiple prognostic factors were evaluated in respect to nodal status. This study adds credence to primary surgical staging with total pelvic and paraaortic lymphadenectomy regardless of presence or absence of the various risk factors.