Introduction/Background Accurate staging is crucial in endometrial cancer management, particularly for lombo-aortic lymph node involvement. The therapeutic role of lombo-aortic lymphadenectomy remains controversial. This study evaluates its outcomes and current position in endometrial cancer treatment.

Methodology A retrospective study included 50 endometrial cancer patients who underwent surgery with complete pelvic and lombo-aortic lymphadenectomy at a Tunisian medical center.

Results Patients had a mean age of 54 years. All cases underwent complete pelvic and lombo-aortic lymphadenectomy, with average lymph node retrieval of 20.6 in the pelvic region and 21.93 in the lombo-aortic region. Lombo-aortic lymph node involvement was observed in 13 patients (26%), with an average of 8.12 involved nodes. Skip metastasis occurred in 4 patients with negative pelvic lymphadenectomy (8%). Various lymph node regions were affected, primarily inter-aortico-caval, peri-aortic, and peri-caval regions.

Histological type 2 showed higher lombo-aortic lymph node involvement (33.33%) compared to type 1 (22.22%). Lymph node involvement was more common in higher histological grades (2–3), with rates of 47.36% for grade 2–3 tumors and 18.18% for grade 1 tumors. Among patients with myometrial infiltration exceeding 50%, 44.4% had positive lombo-aortic lymphadenectomy, compared to 30% in tumors with infiltration below 50%. Lombo-aortic lymphadenectomy resulted in upstaging of three tumors from initial stages IB, II, and IIIA to stage IIIC, while three tumors initially classified as stage IIIC were downgraded.

Conclusion The role of lombo-aortic lymphadenectomy in endometrial cancer management is better understood. Clear indications exist for its use in most cases. Performing lombo-aortic lymphadenectomy requires technical mastery and quality control.

Disclosures The information presented in this study is based on retrospective data and should be interpreted with caution. The findings and conclusions are specific to the study population and may not be generalizable to all cases of endometrial cancer.