Stage ? Low-risk Type Of Endometrial Cancer Whether Pelvic Lymph Nodes Were Performed For Its Influence On Prognosis

Background:endometrial cancer is one of the most common malignant tumor in the female reproductive system.Due to the clinical manifestations of endometrial cancer is mainly irregular vaginal bleeding,most of the patients in the early stage are diagnosed and treatmented.According to the National Comprehensive Cancer Network(NCCN)guidelines,stage I endometrial cancer patients' surgical procedures indicated include not only hysterectomy and bilateral salpingo-oophorectomy,but also pelvic lymph node dissection.if existing high risk factors,para-aortic lymph node should been cut off.But,for stage I endometrial cancer having low-risk factors,studies have shown that the rate of lymph node metastasis is very low.So the technique of pelvic lymph node dissection can not improve survival,on the contrary,it can increase the risk of surgery.At present,as for the treatment,different countries,clinical centers and physicians have the large differences.Purposes:The aim of this study was analyzed the impact of lymph node dissention on the prognosis of low-risk stage I endometrial carcinoma.At the same time,this study discusses the difference of two kinds of operative methods in operation time,intra-operative blood loss,hospitalization time,postoperative recovery and complications.Methods:We conducted a retrospective study on 72 cases of endometrioid uterine cancer meeting the inclusion standard that involved surgery in the Center of Gynecologic Oncology,The First Affiliated Hospital of Dalian Medical University,from 2007 to 2012.According to the surgery procedure,these patients were divided into two groups,no systemic pelvic lymph node dissection group had 52 cases,systemic pelvic lymph node dissection group had 20 cases,Clinical data,including histology,age at diagnosis,operation time,intra-operative blood loss,postoperative exhaust time,postoperative indwelling catheter time,hospitalization duration,postoperative complications,and outcomes were collected for each patient by look-uping operation records and telephone follow-up.Eventually 49 cases were conducted in the study,including no pelvic lymph node dissection group of 32 cases,pelvic lymph node dissection group of 17 cases.Data analysis was conducted using SPSS statistical software(version 21.0).The relationships between incidence of postoperative complications and 5-year survival rate were compared using the Pearson X2 test or Fisher' s exact test.Comparisons of two groups of quantitative parameters were performed with the Student' s t-test and one way ANOVA,respectively.The quantitative parameters include age,operation time,intra-operative blood loss,postoperative exhaust time,postoperative indwelling catheter time,hospitalization time.Survival time was calculated from the date of diagnosis to the date of death or last follow-up.Results:in this study,23 patients were lost to follow-up in the procedure of telephone follow-up.median follow-up time of all cases was 85 months.All patients·age range was 32-82.the average age was 54.22 ± 10.96.Among the 49 uterine cancer patients,32 cases underwent hysterectomy and bilateral salpingo-oophorectomy,7 cases underwent hysterectomy double appendix resection and systemic pelvic lymph node dissection,total 7 underwent hysterectomy and bilateral salpingo-oophorectomy and selective pelvic lymph node dissection,2 cases underwent expanding hysterectomy and bilateral salpingo-oophorectomy and single side pelvic lymph node dissection,1 case underwent expanding hysterectomy and bilateral salpingo-oophorectomy and systemic pelvic lymph node dissection.1.The prognostic analysis of two groupsNo pelvic lymph node dissection group:30 cases of survival,and 2 cases died,the 5-year survival rate was 93.75%.Pelvic lymph node dissection group:15 cases of survival,2 cases died,the 5-year survival rate was 88.24%.The 5-year survival rate of two kinds of operation was no significant difference statistically(P = 0.602).Pelvic lymph node dissection technique have no effect on the prognosis of patients with stage I low-risk type of endometrial carcinoma.2.Intra-operative situation of two groups The average operation time of no pelvic lymph node dissection group and pelvic lymph node dissection group was 124.69±33.48min and 170.88±56.49min,respectively.The operation time difference of two groups was statistically significant(t = 3.095,P =3.095).Pelvic lymph node dissection extended operation time.The average intra-operative blood loss of two groups was respectively 107.50±82.26ml and 175.88±102.66ml,intra-operative blood loss between the two groups has statistical significance(t = 2.372,P = 2.372).Pelvic lymph node dissection increased intraoperatie blood loss.3.Compare the postoperative recovery of two groupsThe postoperative exhaust time of no pelvic lymph node dissection group and pelvic lymph node dissection group was respectively 2.16±0.57 days(1-4 days),and 2.35±0.49 days(2-3 days).The average postoperative exhaust time of two groups has no statistical difference(t = 1.196,P = 1.196).Pelvic lymph nodes were performed had no effect on postoperative exhaust time.The postoperative urine tube indwelling time of no pelvic lymph node dissection group and pelvic lymph node dissection group was 2.25±0.57 days(2-4 days),and 3.94±3.41 days(2-14 days),respectively.Two groups average indwelling catheter time had no statistically significant difference(t = 2.025,P = 2.025).Pelvic lymph nodes were performed has no obviously increased postoperative indwelling catheter time.The hospitalization time between no pelvic lymph node dissection group and pelvic lymph node dissection group was 17.56±4.78 days(11-34 days)and 18.59±6.99 days(11-39 days).Two groups' average hospital stay had no statistical difference(t = 0.607,P=0.607).Pelvic lymph node cleaning did not increase the length of hospitalization time.4.compare the operative complications of two groupsThe postoperative complications in no pelvic lymph node dissection group have 10 cases(31.25%).The postoperative complications in pelvic lymph node dissection group have 8 cases(47.06%).All patients were not founded intra-operative complications.Some of them have a variety of complications.The accident rate of surgical complication of two groups was not significantly different in statistically(X2 = 1.194,P = 1.194).Pelvic lymph node dissection did not increase the surgical complications.Conclusion:1.stage ? low-risk patients with endometrial cancer only whole uterus double adnexectomy has no effect on the prognosis.2.stage ? low-risk patients with endometrial carcinoma whole uterus double adnexectomy + pelvic lymph node cleaning technique increases the operation time and intraoperative blood loss,pelvic lymph node cleaning is not recommended in these patients.