Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials
Purpose The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer. Methods A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010...
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| Veröffentlicht in: | Annals of surgical oncology 2014-08, Vol.21 (8), p.2755-2761 |
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| container_title | Annals of surgical oncology |
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| creator | Odagiri, Tetsuji Watari, Hidemichi Kato, Tatsuya Mitamura, Takashi Hosaka, Masayoshi Sudo, Satoko Takeda, Mahito Kobayashi, Noriko Dong, Peixin Todo, Yukiharu Kudo, Masataka Sakuragi, Noriaki |
| description | Purpose
The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.
Methods
A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.
Results
Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.
Conclusion
Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer. |
| doi_str_mv | 10.1245/s10434-014-3663-0 |
| format | Article |
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The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.
Methods
A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.
Results
Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.
Conclusion
Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-014-3663-0</identifier><identifier>PMID: 24705578</identifier><language>eng</language><publisher>Boston: Springer US</publisher><subject>Adult ; Aged ; Endometrial Neoplasms - mortality ; Endometrial Neoplasms - pathology ; Endometrial Neoplasms - surgery ; Female ; Follow-Up Studies ; Gynecologic Oncology ; Humans ; Lymph Node Excision ; Lymphatic Metastasis ; Medicine ; Medicine & Public Health ; Middle Aged ; Neoplasm Grading ; Neoplasm Invasiveness ; Neoplasm Staging ; Oncology ; Para-Aortic Bodies - pathology ; Pelvic Neoplasms - mortality ; Pelvic Neoplasms - secondary ; Pelvic Neoplasms - surgery ; Prognosis ; Surgery ; Surgical Oncology ; Survival Rate ; Young Adult</subject><ispartof>Annals of surgical oncology, 2014-08, Vol.21 (8), p.2755-2761</ispartof><rights>Society of Surgical Oncology 2014</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c508t-765c42977ec4902bb0f466773f807ada9bc8cc953ed49587255b959c0cc0d8653</citedby><cites>FETCH-LOGICAL-c508t-765c42977ec4902bb0f466773f807ada9bc8cc953ed49587255b959c0cc0d8653</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-014-3663-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-014-3663-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24705578$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Odagiri, Tetsuji</creatorcontrib><creatorcontrib>Watari, Hidemichi</creatorcontrib><creatorcontrib>Kato, Tatsuya</creatorcontrib><creatorcontrib>Mitamura, Takashi</creatorcontrib><creatorcontrib>Hosaka, Masayoshi</creatorcontrib><creatorcontrib>Sudo, Satoko</creatorcontrib><creatorcontrib>Takeda, Mahito</creatorcontrib><creatorcontrib>Kobayashi, Noriko</creatorcontrib><creatorcontrib>Dong, Peixin</creatorcontrib><creatorcontrib>Todo, Yukiharu</creatorcontrib><creatorcontrib>Kudo, Masataka</creatorcontrib><creatorcontrib>Sakuragi, Noriaki</creatorcontrib><title>Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Purpose
The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.
Methods
A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.
Results
Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.
Conclusion
Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer.</description><subject>Adult</subject><subject>Aged</subject><subject>Endometrial Neoplasms - mortality</subject><subject>Endometrial Neoplasms - pathology</subject><subject>Endometrial Neoplasms - surgery</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Gynecologic Oncology</subject><subject>Humans</subject><subject>Lymph Node Excision</subject><subject>Lymphatic Metastasis</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Neoplasm Grading</subject><subject>Neoplasm Invasiveness</subject><subject>Neoplasm Staging</subject><subject>Oncology</subject><subject>Para-Aortic Bodies - pathology</subject><subject>Pelvic Neoplasms - mortality</subject><subject>Pelvic Neoplasms - secondary</subject><subject>Pelvic Neoplasms - surgery</subject><subject>Prognosis</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Survival Rate</subject><subject>Young Adult</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNp1kc9q3DAQxkVpaJJNH6CXIuilF7eSJVlWb8vmTwubZCHJ2cjyeKtgS64kF_bt-mjVZtNSAgXBDKPffDPDh9A7Sj7RkovPkRLOeEEoL1hVsYK8QidU5Aqvavo656SqC1VW4hidxvhICJWMiDfouOSSCCHrE_Tr3MYUbDsn6x32PV7vxuk7vvEd4GtIOuZnI76zCSK2Dl-4zo-QO_SAV9oZCPjBdRC23rotvtvFBKNO1uANDD9z0K7DGx10sfRhX36S1x04MMmPuy94iTfBTz5mvTz9dkp2zOkLDPc-4Ms5zQHwarDOmszc75eIZ-iozwHePscFeri8uF99Lda3V99Wy3VhBKlTIStheKmkBMMVKduW9LyqpGR9TaTutGpNbYwSDDquRC1LIVollCHGkK6uBFugjwfdKfgfM8TUjDYaGAbtwM-xoYKzsi5VdmSBPrxAH_0cXN7uiSKMc8EyRQ-UCT7GAH0zhXx72DWUNHt7m4O9Tba32dvbkNzz_ll5bkfo_nb88TMD5QGI-cttIfwz-r-qvwHn1rKd</recordid><startdate>20140801</startdate><enddate>20140801</enddate><creator>Odagiri, Tetsuji</creator><creator>Watari, Hidemichi</creator><creator>Kato, Tatsuya</creator><creator>Mitamura, Takashi</creator><creator>Hosaka, Masayoshi</creator><creator>Sudo, Satoko</creator><creator>Takeda, Mahito</creator><creator>Kobayashi, Noriko</creator><creator>Dong, Peixin</creator><creator>Todo, Yukiharu</creator><creator>Kudo, Masataka</creator><creator>Sakuragi, Noriaki</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20140801</creationdate><title>Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials</title><author>Odagiri, Tetsuji ; Watari, Hidemichi ; Kato, Tatsuya ; Mitamura, Takashi ; Hosaka, Masayoshi ; Sudo, Satoko ; Takeda, Mahito ; Kobayashi, Noriko ; Dong, Peixin ; Todo, Yukiharu ; Kudo, Masataka ; Sakuragi, Noriaki</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c508t-765c42977ec4902bb0f466773f807ada9bc8cc953ed49587255b959c0cc0d8653</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Endometrial Neoplasms - mortality</topic><topic>Endometrial Neoplasms - pathology</topic><topic>Endometrial Neoplasms - surgery</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Gynecologic Oncology</topic><topic>Humans</topic><topic>Lymph Node Excision</topic><topic>Lymphatic Metastasis</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Neoplasm Grading</topic><topic>Neoplasm Invasiveness</topic><topic>Neoplasm Staging</topic><topic>Oncology</topic><topic>Para-Aortic Bodies - pathology</topic><topic>Pelvic Neoplasms - mortality</topic><topic>Pelvic Neoplasms - secondary</topic><topic>Pelvic Neoplasms - surgery</topic><topic>Prognosis</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Survival Rate</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Odagiri, Tetsuji</creatorcontrib><creatorcontrib>Watari, Hidemichi</creatorcontrib><creatorcontrib>Kato, Tatsuya</creatorcontrib><creatorcontrib>Mitamura, Takashi</creatorcontrib><creatorcontrib>Hosaka, Masayoshi</creatorcontrib><creatorcontrib>Sudo, Satoko</creatorcontrib><creatorcontrib>Takeda, Mahito</creatorcontrib><creatorcontrib>Kobayashi, Noriko</creatorcontrib><creatorcontrib>Dong, Peixin</creatorcontrib><creatorcontrib>Todo, Yukiharu</creatorcontrib><creatorcontrib>Kudo, Masataka</creatorcontrib><creatorcontrib>Sakuragi, Noriaki</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Odagiri, Tetsuji</au><au>Watari, Hidemichi</au><au>Kato, Tatsuya</au><au>Mitamura, Takashi</au><au>Hosaka, Masayoshi</au><au>Sudo, Satoko</au><au>Takeda, Mahito</au><au>Kobayashi, Noriko</au><au>Dong, Peixin</au><au>Todo, Yukiharu</au><au>Kudo, Masataka</au><au>Sakuragi, Noriaki</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2014-08-01</date><risdate>2014</risdate><volume>21</volume><issue>8</issue><spage>2755</spage><epage>2761</epage><pages>2755-2761</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Purpose
The aim of this study was to demonstrate the precise mapping of lymph node metastasis (LNM) sites in endometrial cancer.
Methods
A total of 266 patients who underwent primary radical surgery including systematic pelvic and para-aortic lymphadenectomy for endometrial cancer from 1993 to 2010 were enrolled in this study. We removed lymph nodes from the femoral ring to the para-aortic node up to the level of renal veins. We analyzed the distribution of positive-node sites according to their anatomical location.
Results
Overall, 42 of 266 patients (15.8 %) showed LNM. The median number of nodes harvested was 62.5 (range 40–119) in pelvic nodes (PLN), and 20 (range 3–47) in para-aortic nodes (PAN). Among 42 cases with positive-nodes, 16 cases (38.1 %) showed positive PLN alone, 7 cases (16.7 %) in PAN alone, and 19 cases (45.2 %) in both PLN and PAN. The most prevalent site of positive-nodes was PAN (9.8 %) followed by obturator nodes (9.4 %), internal iliac nodes (7.1 %), and common iliac nodes (5.6 %). Six of 19 cases (31.6 %) of positive PAN above the inferior mesenteric artery (IMA) showed negative PAN below IMA. Metastasis to the deep inguinal nodes was found to be extremely rare (0.38 %). Single-site LNM was the most frequently observed in obturator nodes, followed by PAN above IMA.
Conclusion
Routine resection of deep inguinal nodes is not recommended, whereas para-aortic lymphadenectomy should be extended up to the level of renal veins for endometrial cancer.</abstract><cop>Boston</cop><pub>Springer US</pub><pmid>24705578</pmid><doi>10.1245/s10434-014-3663-0</doi><tpages>7</tpages></addata></record> |
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| ispartof | Annals of surgical oncology, 2014-08, Vol.21 (8), p.2755-2761 |
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| subjects | Adult Aged Endometrial Neoplasms - mortality Endometrial Neoplasms - pathology Endometrial Neoplasms - surgery Female Follow-Up Studies Gynecologic Oncology Humans Lymph Node Excision Lymphatic Metastasis Medicine Medicine & Public Health Middle Aged Neoplasm Grading Neoplasm Invasiveness Neoplasm Staging Oncology Para-Aortic Bodies - pathology Pelvic Neoplasms - mortality Pelvic Neoplasms - secondary Pelvic Neoplasms - surgery Prognosis Surgery Surgical Oncology Survival Rate Young Adult |
| title | Distribution of Lymph Node Metastasis Sites in Endometrial Cancer Undergoing Systematic Pelvic and Para-Aortic Lymphadenectomy: A Proposal of Optimal Lymphadenectomy for Future Clinical Trials |
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