Zhang Haiyan, Zuo Zhi, Wang Ye, Wang Li, Zhu Zhiling
Department of Gynecology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai 200011, P.R. China.
Oncol Lett. 2012 Dec;4(6):1361-1365. doi: 10.3892/ol.2012.919. Epub 2012 Sep 17.
The current study sought to assess the role of paraaortic lymphadenectomy (LNE) in females with endometrial cancer. A retrospective analysis of patients diagnosed with endometrial cancer of stage IA to II preoperatively, between 2009 and 2011 was conducted. Patients were included who had suffered from endometrial cancer without preoperative adjuvant therapy and who underwent hysterectomy plus systematic pelvic LNE and paraaortic LNE by laparoscopy or laparotomy. A total of 54 patients who underwent surgery for preoperative endometrial cancer were selected. All patients underwent LNE. The incidences of pelvic and paraaortic lymph node metastases were 11.1% (6/54) and 7.4% (4/54), with a total positive lymph node rate of 14.8% (8/54). In addition, among the 8 positive cases, 5 patients underwent laparotomy and 3 underwent laparoscopy; 3 cases were classified as stage I and 5 as stage II preoperatively. Of these, 7 patients were identified with pathology-related risk factors, including low differentiation or clear cell adenocarcinoma postoperatively. Discordance of pathological differentiation between the pre- and postoperative stages reached 57.1% (4/7). The results revealed the high occurrence of positive lymph nodes in endometrial cancer which demonstrate the importance of systematic LNE. Additonally, no severe complications were caused by LNE besides lymph cysts. In summary, it is neccesary to perform LNE, particularly the removal of the paraaortic lymph node, in patients with endometrial cancers in order to improve postoperative therapy. Laparoscopy has similar surgical effects as laparotomy, but has a number of advantages.
本研究旨在评估腹主动脉旁淋巴结清扫术（LNE）在子宫内膜癌女性患者中的作用。对2009年至2011年间术前诊断为IA期至II期子宫内膜癌的患者进行了回顾性分析。纳入的患者为未接受术前辅助治疗的子宫内膜癌患者，且通过腹腔镜或开腹手术接受了子宫切除术加系统性盆腔LNE和腹主动脉旁LNE。共选择了54例接受术前子宫内膜癌手术的患者。所有患者均接受了LNE。盆腔和腹主动脉旁淋巴结转移的发生率分别为11.1%（6/54）和7.4%（4/54），总阳性淋巴结率为14.8%（8/54）。此外，在8例阳性病例中，5例患者接受了开腹手术，3例接受了腹腔镜手术；术前3例被分类为I期，5例为II期。其中，7例患者被确定有病理相关危险因素，包括术后低分化或透明细胞腺癌。术前和术后阶段病理分化的不一致率达到57.1%（4/7）。结果显示子宫内膜癌中阳性淋巴结的发生率较高，这表明系统性LNE的重要性。此外，除了淋巴囊肿外，LNE未引起严重并发症。总之，对于子宫内膜癌患者，进行LNE，尤其是切除腹主动脉旁淋巴结，以改善术后治疗是必要的。腹腔镜手术与开腹手术具有相似的手术效果，但有许多优点。
