Role of Lymphadenectomy in Endometrial Cancer

Endometrial cancer is the most frequent gynaecological carcinoma with an increasing incidence. However, this tumour is usually identified in its early stages due to its symptomatology appearing fairly soon. This fact allows for a diagnosis in early stages in most patients, thus providing a good prognosis with an overall survival rate at 5 years higher than 95%. The classical management has been hysterectomy with bilateral salpingo-oophorectomy and pelvic-aortic lymphadenectomy, but we know that many patients in early stages may be treated with only hysterectomy plus salpingooophorectomy. The role of lymphadenectomy in the surgical treatment of these patients is a controversial issue. Assessment of regional nodes varies from elective omission to sampling (selective assessment) to systematic pelvic and para-aortic lymphadenectomy. In order to prevent under or overtreatment, some authors also propose pelvic lymphadenectomy and, in case of it being positive proceed to an aortic lymphadenectomy. At present this technical procedure seems to be useful only in high-risk patients since low-risk patients would not obtain real benefits. Taking into account that in endometrial cancer the drainage is through the pelvic and para-aortic lymph nodes, lymphadenectomy should include all the nodal regions mentioned. Lymphadenectomy allows for a selection of high-risk patients candidates for adjuvant therapy.