Abstract
Background: The diffusion of pelvic and para-aortic lymphadenectomy for the surgical pathological staging of endometrial carcinoma into clinical practice has been evaluated only with questionnaire surveys of gynecological oncologists. No population-based information is available.
Methods: In this study of operable endometrial carcinoma cases registered by the population-based Romagna Cancer Registry (northern Italy) between 1987 and 1994, the association of demographic (age, time period, place of birth, place of residence, place of treatment, and marital status) and pathological factors (histological type, tumor grade, myoinvasion, and extension of disease to cervix, serosa, adnexa, and vagina) with the probability of lymphadenectomy was evaluated by multiple logistic regression analysis.
Results: Of the 300 potentially eligible cases, sufficient information was obtained for 276 (92%; median age, 63 years; range, 33–87 years). No case of para-aortic lymphadenectomy was observed. Pelvic lymphadenectomy was performed in 86 (31%) cases. The probability of pelvic lymphadenectomy was related to tumor grade (positive association), place of treatment, and marital status. All other variables, including myoinvasion and extension of disease to the cervix and beyond the uterus, had no effect whatsoever.
Conclusions: The most likely interpretations of results include poor acceptance of current surgical pathological staging criteria and insufficient use of standard diagnostic techniques for preoperative and intraoperative assessment of myoinvasion and extrauterine spread.
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References
Mikuta JJ. International Federation of Gynecology and Obstetrics staging of endometrial cancer. Cancer 1993; 71: 1460–3.
Homesley HD, Zaino R. Endometrial cancer: prognostic factors. Semin Oncol 1994; 21: 71–8.
Mikuta JJ. Preoperative evaluation and staging of endometrial cancer. Cancer 1995; 76: 2041–3.
Yokoyama Y, Maruyama H, Sato S, Saito Y. Indispensability of pelvic and paraaortic lymphadenectomy in endometrial cancers. Gynecol Oncol 1997; 64: 411–7.
Barnes MN, Kilgore LC. Complete surgical staging of early endometrial adenocarcinoma: optimizing patient outcome. Semin Radiat Oncol 2000; 10: 3–7.
Creasman WT. Limited disease: role of surgery. Semin Oncol 1994; 21: 79–83.
Geisler JP, Wiemann MC, Zhou Z, Miller GA, Geisler HE. Using FIGO histologic grade to determine when to perform lymphadenectomies in endometrioid adenocarcinoma of the endometrium. Eur J Gynaecol Oncol 1996; 17: 204–7.
Belinson JL, Lee KR, Badger GJ, Pretorius RG, Jarrel MA. Clinical stage I adenocarcinoma of the endometrium: analysis of recurrences and the potential benefit of staging lymphadenectomy. Gynecol Oncol 1992; 44: 17–23.
Descamps P, Body G, Calais G, et al. Stage I and II endometrial cancer: should lymphadenectomy still be done? J Gynecol Obstet Biol Reprod 1995; 24: 794–801.
Faught W, Krepart GV, Lotocki R, Heywood M. Should selective paraaortic lymphadenectomy be part of surgical staging for endometrial cancer? Gynecol Oncol 1994; 55: 51–5.
Maggino T, Romagnolo C, Zola P, Sartori E, Landoni F, Gadducci A. An analysis of approaches to the treatment of endometrial cancer in western Europe: a CTF study. Eur J Cancer 1995; 31A: 1993–7.
Gretz HFIII, Economos K, Husain A, et al. The practice of surgical staging and its impact on adjuvant treatment recommendations in patients with stage I endometrial carcinoma. Gynecol Oncol 1996; 61: 409–15.
Maggino T, Romagnolo C, Landoni F, Sartori E, Zola P, Gadducci A. An analysis of approaches to the management of endometrial cancer in North America: a CTF study. Gynecol Oncol 1998; 68: 274–9.
Konno R, Sato S, Yajima A. A questionnaire survey on current surgical procedures for endometrial cancer in Japan. Tohoku J Exp Med 2000; 190: 193–203.
Parkin DM, Whelan SL, Ferlay J, Raymond L, Young J. Cancer Incidence in Five Continents. Vol 7. Lyon: International Agency for Research on Cancer, 1997.
World Health Organization. International Classification of Diseases for Oncology. Geneva: World Health Organization, 1976.
MacLennan R. Items of patient information which may be collected by registries.In: Jensen OM, Parkin DM, MacLennan R, Muir CS, Skeet RG, eds. Cancer Registration: Principles and Methods. Lyon: International Agency for Research on Cancer, 1991: 43–63.
Larson DM, Johnson K, Olson KA. Pelvic and para-aortic lymphadenectomy for surgical staging of endometrial cancer: morbidity and mortality. Obstet Gynecol 1992; 79: 998–1001.
Wolfson AH, Sightler SE, Markoe AM, et al. The prognostic significance of surgical staging for carcinoma of the endometrium. Gynecol Oncol 1992; 45: 142–6.
Creasman WT, DeGeest K, DiSaia PJ, Zaino RJ. Significance of true surgical pathologic staging: a Gynecologic Oncology Group study. Am J Obstet Gynecol 1999; 181: 31–4.
Shipley CFIII, Smith ST, Dennis EJIII, Nelson GH. Evaluation of pretreatment transvaginal ultrasonography in the management of patients with endometrial carcinoma. Am J Obstet Gynecol 1992; 167: 406–11.
Gusberg SB. Virulence factors in endometrial cancer. Cancer 1993; 71: 1464–6.
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Amadori, A., Bucchi, L., Gori, G. et al. Frequency and Determinants of Lymphadenectomy in Endometrial Carcinoma: A Population-Based Study From Northern Italy. Ann Surg Oncol 8, 723–728 (2001). https://doi.org/10.1007/s10434-001-0723-z
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DOI: https://doi.org/10.1007/s10434-001-0723-z