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1 - The comparison of surgical pathologic factors according to metastatic lymph node region in endometrial cancer
Taner Turan, Gökhan Açmaz, Sezin Ertürk, Burcu Gündoğdu, Nejat Özgül, Nurettin Boran
Objective: Aim of this study was; investigation of surgical and pathological risk factors in endometrial cancer and comparison of two groups for surgical and pathological risk factors; endometrial cancer patients with isolated pelvic lymph node (LN) metastasis and endometrial cancer patients with para-aortic +/- pelvic LN metastasis.
Materials and Methods: The cases were staged according to the FIGO 1988 criteria. As standard procedure, total abdominal hysterectomy, bilateral salphingo-oophorectomy, systematic lymphadenectomy and omental biopsy were performed for surgical staging. In this study; we examined pathologic results of endometrial cancer patients at the stage of IIIC-IVB and we examined pathologic results of endometrial cancer cases with pelvic and para-aortic lymphadenectomy up to left renal vein. Forty-six patients were included.
Results: The mean age of patients was 59.6 years. The mean number of lymph node removed was 61.7. The harvested lymph node was 20.9 for para-aortic region and 41.1 for pelvic region. 40 had pelvic and 27 had para-aortic LN metastasis. 19 cases had only pelvic, six had only para-aortic and 21 had pelvic and para-aortic LN metastasis. The surgical risk factors were similar between the groups, except the presence of lymphovascular space invasion (LVSI). LVSI was detected in 84.2% of cases with para-aortic LN metastasis, but in only 50% of cases in which metastasis were isolated pelvic LN metastasis (p= 0.035). 25.9% of the patients with para-aortic LN metastasis had tubal metastasis and positive peritoneal cytology. This ratio was 10.5% in other group. Age, size of tumor and number of removed lymph nodes were similar between groups.
Conclusion: The surgical and pathologic factors affecting prognosis didnt differ, except for LVSI, in patients with para-aortic LN metastasis compared patients with isolated pelvic LN metastasis. LVSI is the most important surgical and pathologic risk factor for PALNM. In the presence of LVSI, para-aortic lymph node dissection should be performed.
Keywords: Endometrial neoplasm, lymphatic metastasis, risk factors
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