SHOULD SELECTIVE PARAAORTIC LYMPHADENECTOMY BE PART OF SURGICAL STAGING FOR ENDOMETRIAL CANCER

Surgical staging of adenocarcinoma of the endometrium attempts to iden tify the true distribution of disease. The survival value of paraaorti c lymphadenectomy selectively performed in patients with histologic ri sk factors is unproven. The objective of this study was to determine i f a staging procedure that did not include paraaortic lymphadenectomy predicted recurrence-free survival in disease surgically confined to t he uterus. Between 1978 and 1990, 273 patients underwent surgical stag ing. Two hundred and sixty-nine were clincal stage I and 4 were stage II. The staging procedure included peritoneal cytology, TAH and BSO, a nd pelvic lymphadenectomy. Postoperative therapy, if any, consisted of whole pelvis and vault radiotherapy in disease confined to the uterus and systemic chemotherapy in patients with extrauterine disease. Surg ical staging resulted in 220 (81%) stage I, 20 (7%) stage II, 27 (10%) stage III, and 6 (2%) stage IV. Eighty-eight patients in stages I and II had deep myometrial invasion or a grade 3 tumor. There were 12 rec urrences, 8 in stage I and 4 in stage II, in patients with disease con fined to the uterus. Four patients (1.7%) recurred outside the pelvis. Had paraaortic lymphadenectomy been performed in patients with risk f actors, this would have mandated 88 dissections to potentially benefit 4 patients. We conclude that paraaortic lymphadenectomy would have be en of small benefit to these surgically staged patients. (C) 1994 Acad emic Press, Inc.