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A Retrospective Analysis of Postoperative Complications With or Without Para-aortic Lymphadenectomy in Endometrial Cancer
  1. Yosuke Konno, MD*,
  2. Yukiharu Todo, MD, PhD,
  3. Shinichiro Minobe, MD, PhD,
  4. Hidenori Kato, MD, PhD,
  5. Kazuhira Okamoto, MD, PhD,
  6. Satoko Sudo, MD, PhD*,
  7. Mahito Takeda, MD, PhD*,
  8. Hidemichi Watari, MD, PhD*,
  9. Masanori Kaneuchi, MD, PhD* and
  10. Noriaki Sakuragi, MD, PhD*
  1. * Department of Obstetrics and Gynaecology, Hokkaido University School of Medicine, Sapporo, Japan; and
  2. Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, Sapporo, Japan.
  1. Address correspondence and reprint requests to Yukiharu Todo, MD, PhD, Division of Gynecologic Oncology, National Hospital Organization, Hokkaido Cancer Center, 4-2, Kikusui, Shiroishi-Ku, Sapporo 003-0804, Japan. E-mail: yukiharu{at}sap-cc.go.jp.

Abstract

Introduction: Although para-aortic lymphadenectomy (PALX) has not been accepted as a standard treatment for patients with endometrial cancer, it is possible that systematic lymphadenectomy including PALX has therapeutic significance for patients with intermediate-/high-risk endometrial cancer. On the other hand, a consensus regarding the safety of PALX has not been reached. The aim of this study was to compare the incidence rates of postoperative complications after pelvic lymphadenectomy (PLX) with or without PALX in patients with uterine corpus cancer.

Methods: A retrospective chart review was carried out for all patients with endometrial cancer treated at 2 tertiary centers between 1998 and 2004. Surgery at one institute included both PLX and PALX, whereas PLX alone was routinely performed at the other institute. A total of 142 patients underwent PLX + PALX and 138 patients underwent PLX alone. We evaluated postoperative complications including intraoperative injury, ileus, lymphedema, lymphocyst, and thrombosis.

Results: There was no fatal accident associated with surgery. Lymphedema was the most frequent complication. Comparing the PLX + PALX group and the PLX group, there were no significant differences in the rate of cases of lymphedema (23.2% vs 28.3%), lymphocyst (9.2% vs 9.4%), and thrombosis (4.9% vs 2.2%). The rate of cases of mild/moderate ileus in the PLX + PALX group was significantly higher than that in the PLX group (10.5% vs 2.9%; P = 0.011). However, no significant difference in the rates of cases of severe ileus was found between the 2 groups (1.4% vs 0.7%). There were also no significant differences between the 2 groups in the rates of intraoperative organ injury (2.8% vs 2.2%) and secondary operation for postoperative complications (4.9% vs 4.3%).

Conclusions: Para-aortic lymphadenectomy can be performed with an acceptable morbidity under the conditions in which it is performed by experienced surgeons, and measures to prevent complications are properly taken.

  • Endometrial cancer
  • Para-aortic lymphadenectomy
  • Complication
  • Ileus
  • Lymphedema

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Footnotes

  • The authors have no conflict of interest about the research content, conclusions, and significance of this study.