We aimed to investigate whether systemic
lymphadenectomy is beneficial for patients with early
endometrial cancer. For this purpose, we analyzed a population-based registry with of 2392 women with endometrioid
endometrial cancer, stage I and II at intermediate and high risk of recurrence. The primary outcome measure was overall survival.
RESULTS: After exclusions, 868 women were eligible for analysis. Of those, 511 and 357 were categorized as intermediate (pT1A G3 and pT1B G1-2) and high risk (pT1B G3 and pT2 G1-3) early stage
endometrial cancer, respectively.
Lymphadenectomy was performed in 527 (60.7%) of the cases. Patients in the
lymphadenectomy group were significantly younger, presented with more
tumors of intermediate or undifferentiated grade and exhibited significantly lower co-morbidity rates and Eastern Cooperative of Oncology Group (ECOG) performance status. Median follow-up was 6.7 years. Recurrence-free survival was not improved by
lymphadenectomy in the intermediate and high-risk group of patients. During the follow-up period, 111 (12.8%) women had disease recurrence and 302 (34.8%) died. Systematic
lymphadenectomy was associated with significant improvement of overall survival in the pT1A G3 and pT1B G3 patient subgroups. Notably, adjustment for patient age and ECOG status abolished the improvement of overall survival by systematic
lymphadenectomy in all groups. Thus,
lymphadenectomy did not improve recurrence-free survival in the intermediate risk or the high-risk group of patients CONCLUSIONS: Systematic pelvic and para-aortic
lymphadenectomy did not improve the survival of patients with early stage I and II endometrioid
endometrial cancer at intermediate and high risk of recurrence.