Pelvic and para-aortic lymphadenectomy for surgical staging of high-risk endometrioid adenocarcinoma of the endometrium.

The objective of this study was to analyze the results of pelvic and para-aortic lymphadenectomy in high-risk patients with endometrioid adenocarcinoma of the endometrium and no clinical or gross surgical evidence of extrauterine metastases. From August 1987 to October 1992, 50 patients with high-risk endometrioid adenocarcinoma of the endometrium had pelvic and para-aortic lymphadenectomy performed. The median number of lymph nodes removed was 18. No preoperative radiotherapy was administered. Pelvic lymph node metastases (20.0%) and para-aortic lymph node metastases (16.0%) were the most common sites of extrauterine metastases diagnosed. Eight patients (80.0%) with pelvic lymph node metastases also had para-aortic metastases. All 8 patients with para-aortic lymph node metastases had pelvic lymph node metastases. Pelvic lymphadenopathy was diagnosed on surgical exploration in 30% of patients with pelvic lymph node metastases, and para-aortic lymphadenopathy was present in 50% with para-aortic metastases. Six of 46 patients (13.0%) without pelvic or para-aortic lymphadenopathy had microscopic lymph node metastases. Palpation of the pelvic and para-aortic lymph node areas alone is inadequate in identifying patients with lymph node metastases. The addition of routine pelvic and para-aortic lymphadenectomy to TAH/BSO will identify subclinical lymph node metastases in a significant number of patients who may benefit from individualized postoperative therapy.