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EP601 Pelvic and para-aortic versus pelvic lymphadenectomy in intermediate and high risk endometrial cancer: a systematic review and meta-analysis
  1. S Petousis1,
  2. C Panagiotis2,
  3. C Margioula-Siarkou2,
  4. A Papanikolaou1,
  5. A Athanasiadis2,
  6. A Rodolakis3,
  7. I Vergote4 and
  8. I Kalogiannidis2
  1. 12nd Department of Obstetrics and Gynaecology
  2. 23rd Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki
  3. 31st Department of Obstetrics and Gynaecology, Kapodestrian University of Athens, Athens, Greece
  4. 4Department of Gynaecologic Oncology, KU Leuven, Leuven, Belgium


Introduction/Background As the extend of lymphadenectomy for endometrial cancer remains controversial, a systematic review and meta-analysis was performed to assess the impact of combined pelvic and para-aortic lymph node dissection (PPALND) compared to only pelvic lymph node dissection (PLND) on survival outcomes of intermediate and/or high-risk patients.

Methodology Databases were searched up to 20 April 2018. Primary outcomes were overall survival (OS) and disease free survival (DFS). Secondary outcomes were the need for radiotherapy/chemotherapy/combined/adjuvant therapy, pelvic, para-aortic, intra-pelvic and extra-pelvic node recurrence, time to recurrence, pelvic, para-aortic and any node invasion rate at surgery. Pooled risk ratios were calculated using random effects models. Risk of bias of individual studies was assessed using the ROBINS-I tool. PROSPERO’s registration number is CRD42017072337.

Results 13 studies were identified with 7349 patients. PPALND was associated with 46% decreased risk for death (HR: 0·54, 95% CI: 0·35–0·83) and increased 5-year DFS rate (RR: 1·13, 95% CI: 1·04–1·23). Furthermore, PPALND was associated with 49% decreased risk for recurrence (HR: 0·51, 95% CI:0·28–0·93), decreased need for radiotherapy (RR: 0·69, 95% CI:0·52–0·92), while increased risk for chemotherapy (RR: 1·71, 95% CI:1·36–2·14) was observed in the present study. There was no significant difference for adjuvant (RR: 0·98, 95% CI: 0·87–1·10) or combined therapy (RR: 1·45, 95% CI: 0·75–2·78). Para-aortic recurrence rate was higher for patients with only PLND (9·1% vs 5·2%), however with no significant difference (RR: 0·32, 95% CI: 0·04–2·55). There was limited evidence for intra-pelvic, extra-pelvic, pelvic node recurrence and time to recurrence. Risk of bias was critical or serious for all studies.

Conclusion There is low-quality evidence that PPALND contributes to improved survival outcomes in women with intermediate/high-risk endometrial cancer.

Disclosure Nothing to disclose.

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