Introduction Randomised Control Trials have not demonstrated a survival benefit for pelvic lymphadenectomy (PL) in endometrial cancer (EC) surgery, but it has been advocated to triage high and intermediate risk disease to avoid external beam radiotherapy (EBRT) in node negative patients. A recent review of the Cancer Outcomes and Services Data in England, showed geographical variations in PL and EBRT rates, identifying Kent and Medway (K&M) Alliance as an outlier with high PL rates. We reviewed granular patient data of the K&M cohort to assess the clinical indications for PL, its impact on triage of adjuvant ERBT, and clinical outcomes.
Methods Retrospective case review EC cases in 2013–2016 in two gynaecological oncology centres and two district hospitals in K&M.
Results 668 of 815 cases were accessed. 295/550 (53%) FIGO stage IA to IIIC undergoing primary surgery had PL. This group had a higher recurrence rate (47/295,16%), compared to no PL (17/255,7%). 88/295 (30%) had EBRT following PL, 70% of which had proven extrauterine disease (FIGO stage II to IIIc). Recurrence after PL + EBRT (24/88,27%) was higher than PL only (23/207,11%) but most were systemic disease outwith the EBRT field. There was no significant difference in pelvic recurrence between these high/intermediate risk cohorts triaged for EBRT with PL.
Conclusions PL at primary surgery enabled management of selected node negative intermediate/high risk histology EC without adjuvant EBRT, with comparable pelvic recurrence to irradiated node positive cases. A comparison of outcomes from the national cohorts comparing varying management pathways would provide further insight into the impact of these interventions.
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