Lymphadenectomy in high risk endometrial carcinoma stage I and II: no moremorbidity and no need for external pelvic radiation

The objectives of this retrospective study were to analyze the morbidity of surgical staging and to evaluate the omission of external radiotherapy in high-risk patients with stage I and II endometrial carcinoma when the lymph nodes were negative. From 1988 to 1996, 63 of 117 patients underwent a pelvic and periaortic lym phadenectomy. The decision to perform lymphadenectomy was influenced by pat ient general health. Patients with lymphadenectomy had a better physical status (P < 0.0001). Ly mphadenectomy increased mean operative time (P < 0.0001) and blood loss (P < 0.01), but there was no increase in postoperative complications. At a med ian follow-up of 54 months, there was one cuff recurrence in 56 patients. N ineteen high-risk patients without external pelvic radiation had the same d isease-free survival rate as 37 low-risk patients (P = 0.1). In the group w ithout lymphadenectomy, the disease-free survival for 18 high-risk patients and 32 low-risk patients was similar (P = 0.21). Surgical staging in properly selected patients does not increase postoperat ive complications and brachytherapy without external radiotherapy is associ ated with excellent disease-free survival when the lymph nodes are negative .