LONG-TERM OUTCOMES OF THERAPEUTIC PELVIC LYMPHADENECTOMY FOR STAGE-I ENDOMETRIAL ADENOCARCINOMA

Objective. The treatment of patients with stage I endometrial adenocar cinoma is often shorter and less expensive if total abdominal hysterec tomy (TAH), bilateral salpingo-oophorectomy (BSO), and therapeutic lym phadenectomy are used rather than TAH, BSO, pelvic lymph node sampling , and pelvic external beam radiation. We studied whether the survival and morbidity of patients treated with therapeutic lymphadenectomy are equal to or better than with these alternative treatments. Methods. W e reviewed the medical records of patients with stage I endometrial ad enocarcinoma who were enrolled in the MetroHealth Medical Center tumor registry between 1970 and 1993 after undergoing full pelvic lymph nod e dissection, in addition to total abdominal hysterectomy, bilateral s alpingo-oophorectomy, and vaginal brachytherapy. The mean number of re sected nodes was 33 (median, 31; interquartile range, 19). Patients we re followed for 1.6-20 years (median, 8 years; interquartile range, 5. 8 years). Morbidity and survival rates were compared to published seri es using similar treatment strategies and to those from studies using pelvic external beam radiation and pelvic lymph node sampling rather t han lymphadenectomy. Results. Of 192 patients with pathologic stage I( FIGO 1988) endometrial adenocarcinoma, 178 patients had full pelvic ly mph node dissection; 159 patients were evaluable. The 15-year overall survival was 98%; 10- and 15- year disease-free survivals were 96 and 94%, respectively, Overall morbidity was 18% (29/159), and moderate-to -severe morbidity was 13% (21/159). Recurrences were seen in 4.4% (7/1 59) of patients. Grade and myometrial invasion were not significant pr edictors of disease-free survival after full pelvic lymph node dissect ion (grade, P = 0.42; stage, P = 0.67), The results compare favorably with those of similar studies and with studies of pelvic external beam radiation. Conclusions. Primary surgical management with total abdomi nal hysterectomy, bilateral salpingo-oophorectomy, therapeutic pelvic lymphadenectomy, and vaginal brachytherapy is a viable and possibly pr eferable option for patients with stage I endometrial adenocarcinoma, (C) 1998 academic Press.