The Significance Of Systemic Retroperitoneal Lymphadenectomy For Early Low-risk Endometrioid Adenocarcinoma

ObjectiveRetrospective analysis of the significance of systemic retroperitoneal lymphadenectomy in patients with early-stage low-risk endometrialadenocarcinoma.MethodsFrom June 2008 to August 2017,107 patients with early endometrialadenocarcinoma who underwent primary surgery in Anhui Provincial Hospital and Anhui Provincial Cancer Hospital were divided into two groups according to different surgical methods.The study group was total uterus + bilateral adnexal excision + systemic pelvic lymphadenectomy ± para-aorticlymphadenectomy;The control group was:total uterus + bilateral adnexal excision.4 cases were lost to follow-up,103 cases were complete follow-up data,50 cases in the study group and 53 cases in the control group.The study group was divided into two groups according to whether or not underwent para-aortic lymphadenectomy:PLND group:total uterus + bilateral adnexal excision + systemic pelvic lymphadenectomy;PPaLND group:total uterus + bilateral adnexal excision + systemic pelvic lymphadenectomy +para-aortic lymphadenectomy.The operative time,bleeding volume,postoperative hospitalization days were compared respectively,and the incidence of operative complications rate,recurrence rate,DFS and OS were also compared.The recurrence rate,survival rate,DFS and OS were compared among the early EC patients in the low-risk group.To analysis the value of systematic retroperitoneal lymph node dissection in the treatment of early low-risk endometrioid adenocarcinoma.Results(1)In the study group,the operation time of PLND group was 190.00±29.43min,in the control group was 122.81±35.14min,and the difference between the two groups was statistically significant(P<0.001).(2)The bleeding volume in PLND group was 273.44±178.25 ml and that in control group was 169.81 ± 111.52 ml.The difference was statistically significant(P=0.001).(3)In the study group,the postoperative hospitalization days in PLND group were 11.47 ± 4.49 days,while those in control group were 8.85±5.71.The difference was statistically significant(P<0.05).(4)Comparing the incidence of operative complications,the study group(46%)was significantly higher than the control group(7.55%),the difference between the two groups was statistically significant(P<0.001);PLND group(43.75%)and PPaLND group(50%)had no significant difference(P>0.05).(5)The recurrence rate and survival rate were 6%and 98%in the study group,1.89%and 100%in the control group,respectively.There was no significant difference in recurrence rate and survival rate between the two groups(P>0.05).The survival curve showed no significant difference in DFS and OS between the two groups(P>0.05).(6)The recurrence rate of low-risk patients was 5.71%in the study group and 2.38%in the control group.There was no significant difference between the two groups(P>0.05).The survival curve showed that there was no significant difference in DFS between the two low-risk groups(P>0.05).There were no death in the two groups of low-risk patients,with a survival rate of 100%.Conclusions(1)Systemic retroperitoneal lymphadenectomy can prolong the operation time and postoperative hospitalization days,increase bleeding volume,and lead to complications such as pelvic lymphocyst,perineal and lower limb lymphedema;(2)Systemic retroperitoneal lymphadenectomy did not significantly improve the recurrence,DFS and OS of early low-risk endometrioidadenocarcinoma patients,and did not reflect its therapeutic value;(3)Retroperitoneal lymphadenectomy may not be routinely performed in patients with early low-risk endometrioidadenocarcinomascreened according to the Mayo criteria.