Frequency and determinants of lymphadenectomy in endometrial carcinoma: A population-based study from northern Italy

Background: The diffusion of pelvic and para-aortic lymphadenectomy for the surgical pathological staging of endometrial carcinoma into clinical pract ice has been evaluated only with questionnaire surveys of gynecological onc ologists. No population-based information is available. Methods: In this study of operable endometrial carcinoma cases registered b y the population-based Romagna Cancer Registry (northern Italy) between 198 7 and 1994, the association of demographic (age, time period, place of birt h, place of residence, place of treatment, and marital status) and patholog ical factors (histological type, tumor grade, myoinvasion, and extension of disease to cervix, serosa, adnexa, and vagina) with the probability of lym phadenectomy was evaluated by multiple logistic regression analysis. Results: Of the 300 potentially eligible cases, sufficient information was obtained for 276 (92%; median age, 63 years; range, 33-87 years). No case o f para-aortic lymphadenectomy was observed. Pelvic lymphadenectomy was perf ormed in 86 (31%) cases. The probability of pelvic lymphadenectomy was rela ted to tumor grade (positive association), place of treatment, and marital status. All other variables, including myoinvasion and extension of disease to the cervix and beyond the uterus, had no effect whatsoever. Conclusions: The most likely interpretations of results include poor accept ance of current surgical pathological staging criteria and insufficient use of standard diagnostic techniques for preoperative and intraoperative asse ssment of myoinvasion and extrauterine spread.