Systematic lymphadenectomy in endometrial cancer

Approximately 17% of patients with endometrial cancer eventually relapse and die of this disease. 1 From this viewpoint, improvements are needed in the treatment for endometrial cancer, especially patients at high risk of a poor prognosis. On the other hand, the International Federation of Gynecology and Obstetrics (FIGO) annual report demonstrated that the survival rates of endometrial cancer have continued to increase during recent decades. 3 This trend applies to all cases, including stage IIIC. Meanwhile, surgery has been playing the leading role in treatment of endometrial cancer, and there has been no paradigm shift except for the introduction of lymphadenectomy. Whether many patients with endometrial cancer can benefit from lymphadenectomy must be determined. Two recent randomized controlled trials showed negative effects of lymphadenectomy on prognosis, 4,5 and many gynecologists have since declared at conferences that standard surgery for endometrial cancer does not include lymphadenectomy. However, such a declaration is an overgeneralization of the results of the randomized studies. In the present manuscript, we tried to interpret the results of these two randomized controlled trials properly, and discussed pitfalls of randomized controlled trials in surgical intervention. A surgical field to be treated is proposed in a group of patients who require lymphadenectomy. In addition, a new strategy for preventing leg edema, the most frequent complication after lymphadenectomy, is introduced.

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