Endometrial cancer (EC) is the most common
malignancy of the female reproductive tract and the fourth most common
cancer overall. Approximately 20 % of patients with EC harbor disease outside the uterus, and 10 % of patients initially diagnosed with
cancer confined to the uterus are found to have
lymph node metastases. Para-aortic lymph node involvement occurs in approximately 7-8 % of EC patients overall and in about 50 % of patients with positive pelvic nodes.
Metastases to the para-aortic lymph nodes are associated with poor prognosis. Factors associated with para-aortic lymph node dissemination include advanced stage, high histological grade, deep myometrial invasion, cervical involvement, lymphovascular space involvement, and the presence of pelvic
lymph node metastases. Approximately 77 % of patients with para-aortic nodal involvement are found to have
metastases above the level of the inferior mesenteric artery. Systematic pelvic and para-aortic
lymphadenectomy with dissection optimally carried out to the renal vessels is important in high-risk patients in order to identify nodes present at distant sites, particularly above the inferior mesenteric artery (IMA). While the definitive management of EC varies widely across the gynecological oncology community, there is a consensus that patients at risk for
lymphatic metastases (high and intermediate risk) who are targeted with systematic
lymphadenectomy may have an improved prognosis. Well-designed prospective studies evaluating the therapeutic role of systematic
lymphadenectomy in EC are needed. Herein, we describe the role of para-aortic
lymphadenectomy in the surgical staging of EC emphasizing its prerequisites, extent, and diagnostic and potential therapeutic advantages.