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A Prospective Evaluation of Lymphatic Dissemination in Endometrial Cancer: Is It Adequate to Perform Lymph Node Dissection Up to the Inferior Mesenteric Artery?
  1. Taner Turan*,
  2. Saynur Sarıcı Yılmaz, MD*,
  3. Deniz Hızlı*,
  4. Burcu Gündogdu*,
  5. Nurettin Boran*,
  6. Gökhan Tulunay*,
  7. Ahmet Özfuttu and
  8. M. Faruk Köse*
  1. *Gynecologic Oncology and
  2. Pathology Divisions, Zübeyde Hanım Women's Health Research and Teaching Hospital, Ankara, Turkey.
  1. Address correspondence and reprint requests to Saynur Sarıcı Yılmaz, MD, Tevfik Sağlam Cad 89/7 Etlik, Post Code 06010 Kecioren, Ankara, Turkey. E-mail: saynur77{at}


Objective: This study aimed to assess para-aortic metastases relative to the inferior mesenteric artery (IMA). In addition, the clinicopathologic features of these patients are discussed.

Materials and Methods: Between 2007 and 2009, a total of 78 consecutive patients who had open systematic pelvic and para-aortic lymphadenectomy surgery for endometrial cancer extending to the renal vessels and who were treated at the gynecologic oncology department were included in this prospective study. The para-aortic lymph nodes (PALNs) removed from these patients were classified as supramesenteric (between the renal vein and the IMA) or inframesenteric (between the IMA and the presacral). Patients' clinical data, pathologic tumor characteristics, and operative and early postoperative data were recorded after surgery. Descriptive statistics were calculated using the SPSS 17.0 package program.

Results: Of these 78 patients, 18 (21.3%) had metastatic nodal involvement. From a total of 12 patients with PALN metastasis, 7 had only supramesenteric and 1 had only inframesenteric nodal involvement, whereas 4 had both supramesenteric and inframesenteric metastases. Of the 5 patients in the inframesenteric ± supramesenteric group, none had a grade 1 tumor. On the other hand, of the 7 patients with only supramesenteric metastasis, 57.1% (n = 4) had a grade 1 tumor and 42.8% (n = 3) had less than half of myometrial invasion.

Conclusions: In the case of well-defined risk factors in which a lymphadenectomy is indicated according to current guidelines from the International Federation of Gynecology and Obstetrics, a PALN dissection should be extended up to the renal vessels. We also conclude that tumor grade, histologic type, and myometrial invasion cannot be used as markers to decide on supramesenteric lymphadenectomy in endometrial cancer.

  • Endometrial cancer
  • Lymphadenectomy
  • Inferior mesenteric artery

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