The Clinical Significance Of Para-aortic Lymphadenectomy In Endometrial Carcinoma:a Meta-analysis

Background. Endometrial carcinoma (EC) is one of the most common tumors for females. Total hysterectomy with bilateral salpingo-oophorectomy has been the mainstay of surgical procedures. The publishing of surgical-pathological staging system by FIGO in1988had replaced the older clinical staging system and made the status of complete lymphadenectomy more important. The diagnostic significance of lymphadenectomy has been widely recognized, but the therapeutic effect has long been a matter of great debate. In2009, the newly revised surgical staging system has emphasized the value of para-aortic lymph nodes (PA) in predicting prognosis, but the therapeutic significance and optimal extent of para-aortic lymphadenectomy (PALD) has not come to an agreement.Objective. To assess the clinical significance of PALD in EC.Methods. We searched the PubMed, CNKI and CBM, confined the languages to English and Chinese from the time of1988to2013. The patients in the control group (PLN group) had total hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. The study (the PAN group) group was with PALD in addition to the above procedures. We evaluated the articles retrieved according to the including and excluding criteria. We did Meta-analysis by use of RevMan5.1software.Results. There were six articles in English and none in Chinese we obtained, with1288cases. The results after the Meta-analysis were as followed;1. The study group needed longer time for surgery than the control group (P=0.01<0.05) and the blood loss in operation was more (P=0.002<0.05), as well.2. There were no significant differences in the incidence of lymphedema (P=0.59>0.05), lymphcyst (P=0.16>0.05), important-organ injuries (P=0.15>0.05), wound infection (P=0.73>0.05) and severe ileus (p=0.27>0.05).3. In low-risk patients(FIGO I with G1or G2), there were no significant differences in the five-year disease-free survival (P=0.24>0.05) between the study group and the control group. Among the intermediate to high risk patients, those who were with the ideal PALD demonstrated significantly improved five-year overall survival (P=0.0006＜0.05) and five-year disease-free survival (P=0.002<0.05). But a poor PALD may not obtain advantageous impact.Conclusions. The longer operative time and more blood loss in the study group are within acceptable limits. And the addition of PALD would not induce more severe complications. The therapeutic benefit of PALD on survival may relate with the risk factors for poor prognosis; numbers of removed PA and/or the extent of the surgical procedure. PALD with more removed PA nodes and/or larger extent may improve the survival among intermediate to high risk patients.