Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma

Dasarahally S. Mohan, Michael A Samuels, Mostafa A. Selim, Abdelwahab D. Shalodi, Rodney J. Ellis, Judith Samuels, Hyun J. Yun

Research output: Contribution to journalArticle

171 Citations (Scopus)

Abstract

Objective. The treatment of patients with stage I endometrial adenocarcinoma is often shorter and less expensive if total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and therapeutic lymphadenectomy are used rather than TAH, BSO, pelvic lymph node sampling, and pelvic external beam radiation. We studied whether the survival and morbidity of patients treated with therapeutic lymphadenectomy are equal to or better than with these alternative treatments. Methods. We reviewed the medical records of patients with stage I endometrial adenocarcinoma who were enrolled in the MetroHealth Medical Center tumor registry between 1970 and 1993 after undergoing full pelvic lymph node dissection, in addition to total abdominal hysterectomy, bilateral salpingo-oophorectomy, and vaginal brachytherapy. The mean number of resected nodes was 33 (median, 31; interquartile range, 19). Patients were followed for 1.6-20 years (median, 8 years; interquartile range, 5.8 years). Morbidity and survival rates were compared to published series using similar treatment strategies and to those from studies using pelvic external beam radiation and pelvic lymph node sampling rather than lymphadenectomy. Results. Of 192 patients with pathologic stage I (FIGO 1988) endometrial adenocarcinoma, 178 patients had full pelvic lymph node dissection; 159 patients were evaluable. The 15-year overall survival was 98%; 10- and 15- year disease-free survivals were 96 and 94%, respectively. Overall morbidity was 18% (29/159), and moderate-to- severe morbidity was 13% (21/159). Recurrences were seen in 4.4% (7/159) of patients. Grade and myometrial invasion were not significant predictors of disease-free survival after full pelvic lymph node dissection (grade, P = 0.42; stage, P = 0.67). The results compare favorably with those of similar studies and with studies of pelvic external beam radiation. Conclusions. Primary surgical management with total abdominal hysterectomy, bilateral salpingo-oophorectomy, therapeutic pelvic lymphadenectomy, and vaginal brachytherapy is a viable and possibly preferable option for patients with stage I endometrial adenocarcinoma.

Original languageEnglish
Pages (from-to)165-171
Number of pages7
JournalGynecologic Oncology
Volume70
Issue number2
DOIs
StatePublished - Aug 1 1998
Externally publishedYes

Fingerprint

Lymph Node Excision
Adenocarcinoma
Ovariectomy
Hysterectomy
Morbidity
Therapeutics
Brachytherapy
Radiation
Disease-Free Survival
Lymph Nodes
Survival
Medical Records
Registries
Survival Rate
Recurrence

Keywords

  • Brachytherapy
  • Endometrial carcinoma
  • Lymphadenectomy
  • Morbidity

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Oncology

Cite this

Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. / Mohan, Dasarahally S.; Samuels, Michael A; Selim, Mostafa A.; Shalodi, Abdelwahab D.; Ellis, Rodney J.; Samuels, Judith; Yun, Hyun J.

In: Gynecologic Oncology, Vol. 70, No. 2, 01.08.1998, p. 165-171.

Research output: Contribution to journalArticle

Mohan, Dasarahally S. ; Samuels, Michael A ; Selim, Mostafa A. ; Shalodi, Abdelwahab D. ; Ellis, Rodney J. ; Samuels, Judith ; Yun, Hyun J. / Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. In: Gynecologic Oncology. 1998 ; Vol. 70, No. 2. pp. 165-171.
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AU - Mohan, Dasarahally S.

AU - Samuels, Michael A

AU - Selim, Mostafa A.

AU - Shalodi, Abdelwahab D.

AU - Ellis, Rodney J.

AU - Samuels, Judith

AU - Yun, Hyun J.

PY - 1998/8/1

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N2 - Objective. The treatment of patients with stage I endometrial adenocarcinoma is often shorter and less expensive if total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and therapeutic lymphadenectomy are used rather than TAH, BSO, pelvic lymph node sampling, and pelvic external beam radiation. We studied whether the survival and morbidity of patients treated with therapeutic lymphadenectomy are equal to or better than with these alternative treatments. Methods. We reviewed the medical records of patients with stage I endometrial adenocarcinoma who were enrolled in the MetroHealth Medical Center tumor registry between 1970 and 1993 after undergoing full pelvic lymph node dissection, in addition to total abdominal hysterectomy, bilateral salpingo-oophorectomy, and vaginal brachytherapy. The mean number of resected nodes was 33 (median, 31; interquartile range, 19). Patients were followed for 1.6-20 years (median, 8 years; interquartile range, 5.8 years). Morbidity and survival rates were compared to published series using similar treatment strategies and to those from studies using pelvic external beam radiation and pelvic lymph node sampling rather than lymphadenectomy. Results. Of 192 patients with pathologic stage I (FIGO 1988) endometrial adenocarcinoma, 178 patients had full pelvic lymph node dissection; 159 patients were evaluable. The 15-year overall survival was 98%; 10- and 15- year disease-free survivals were 96 and 94%, respectively. Overall morbidity was 18% (29/159), and moderate-to- severe morbidity was 13% (21/159). Recurrences were seen in 4.4% (7/159) of patients. Grade and myometrial invasion were not significant predictors of disease-free survival after full pelvic lymph node dissection (grade, P = 0.42; stage, P = 0.67). The results compare favorably with those of similar studies and with studies of pelvic external beam radiation. Conclusions. Primary surgical management with total abdominal hysterectomy, bilateral salpingo-oophorectomy, therapeutic pelvic lymphadenectomy, and vaginal brachytherapy is a viable and possibly preferable option for patients with stage I endometrial adenocarcinoma.

AB - Objective. The treatment of patients with stage I endometrial adenocarcinoma is often shorter and less expensive if total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and therapeutic lymphadenectomy are used rather than TAH, BSO, pelvic lymph node sampling, and pelvic external beam radiation. We studied whether the survival and morbidity of patients treated with therapeutic lymphadenectomy are equal to or better than with these alternative treatments. Methods. We reviewed the medical records of patients with stage I endometrial adenocarcinoma who were enrolled in the MetroHealth Medical Center tumor registry between 1970 and 1993 after undergoing full pelvic lymph node dissection, in addition to total abdominal hysterectomy, bilateral salpingo-oophorectomy, and vaginal brachytherapy. The mean number of resected nodes was 33 (median, 31; interquartile range, 19). Patients were followed for 1.6-20 years (median, 8 years; interquartile range, 5.8 years). Morbidity and survival rates were compared to published series using similar treatment strategies and to those from studies using pelvic external beam radiation and pelvic lymph node sampling rather than lymphadenectomy. Results. Of 192 patients with pathologic stage I (FIGO 1988) endometrial adenocarcinoma, 178 patients had full pelvic lymph node dissection; 159 patients were evaluable. The 15-year overall survival was 98%; 10- and 15- year disease-free survivals were 96 and 94%, respectively. Overall morbidity was 18% (29/159), and moderate-to- severe morbidity was 13% (21/159). Recurrences were seen in 4.4% (7/159) of patients. Grade and myometrial invasion were not significant predictors of disease-free survival after full pelvic lymph node dissection (grade, P = 0.42; stage, P = 0.67). The results compare favorably with those of similar studies and with studies of pelvic external beam radiation. Conclusions. Primary surgical management with total abdominal hysterectomy, bilateral salpingo-oophorectomy, therapeutic pelvic lymphadenectomy, and vaginal brachytherapy is a viable and possibly preferable option for patients with stage I endometrial adenocarcinoma.

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KW - Endometrial carcinoma

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