Potential therapeutic role of para-aortic lymphadenectomy in node-positiveendometrial cancer

Objective. The aim of this study was to assess the potential therapeutic ro le of para-aortic lymphadenectomy (PAL) in highrisk patients with endometri al cancer. Methods. We studied two groups of patients with endometrial cancer who unde rwent operation at Mayo Clinic (Rochester, MN) during the interval 1984 to 1993: (1) 137 patients at high risk for para-aortic lymph node involvement (myometrial invasion >50%, palpable positive pelvic nodes, or positive adne xae), excluding stage IV disease, and (2) 51 patients with positive nodes ( pelvic or para-aortic), excluding stage IV disease. By our definition, PAL required removal of five or more para-aortic nodes. Results. In both groups, no significant difference existed between patients who had PAL (PAL+) and those who did not (PAL-) in regard to clinical or p athologic variables, percentage irradiated, or surgical or radiation compli cations. Among the 137 high-risk patients, the 5-year progression-free surv ival was 62% and the 5-year overall survival was 71% for the PAL- group com pared with 77 and 85%, respectively, for the PAL+ group (P = 0.12 and 0.06, respectively). For the 51 patients with positive nodes, the 5-year progres sion-free survival and 5-year overall survival for the PAL- group were 36 a nd 42% compared with 76 and 77% for the PAL+ group (P = 0.02 and 0.05, resp ectively). Lymph node recurrences were detected in 37% of the PAL-patients but in none of the PAL+ patients (P = 0.01). Multivariate analysis suggeste d that submission to PAL was a cogent predictor of progression-free surviva l (odds ratio = 0.25; P = 0.01) and overall survival (odds ratio = 0.23; P = 0.006). Conclusions. These results suggest a potential therapeutic role for formal PAL in endometrial cancer. (C) 2000 Academic Press.