Efficacy of laparoscopic, pelvic and para-aortic lymphadenectomy in the treatment of endometrial carcinoma.

Purpose: To investigate the clinical efficacy and safety of laparoscopic pelvic and para-aortic lymphadenectomy in the treatment of endometrial carcinoma.

Methods: The clinical data of 110 patients with endometrial carcinoma were retrospectively reviewed. All patients were categorized into two groups. The pelvic lymphadenectomy (PLD) group was subjected to pelvic lymph node dissection alone, while the para-aortic lymphadenectomy (PALD)+PLD group underwent pelvic and para-aortic lymphadenectomy. The operation time, intraoperative bleeding, volume of postoperative drainage, number of resected lymph nodes, number of positive lymph nodes, and incidence of postoperative complications were compared between the two groups of patients. In addition, the tumor recurrence and survival were followed up and compared.

Results: The operation time was significantly longer in the PALD+PLD group than that in the PLD group (p<0.001). The average number of resected lymph nodes and the number of positive lymph nodes in the PALD+PLD group were significantly greater than those in the PLD group. The total recurrence rate was 9.1% (5/55) vs. 20.0% (11/55) between the PLD group and PALD+PLD group, indicating a statistically significant difference (p=0.045). Moreover, the recurrence rate of stage III patients was 50.0% (3/6) and 25.0% (5/55) in the PLD group and PALD+PLD group, respectively, showing a statistically significant difference (p=0.034). During the follow-up period, the 3-year overall survival (OS) was 90.9% (50/55) and 96.4% (53/55) in the PLD group and PALD+PLD group, respectively, indicating no statistically significant difference (p=0.249, log-rank test).

Conclusion: Laparoscopic pelvic and para-aortic lymphadenectomy for endometrial carcinoma can increase the number of resected lymph nodes and reduce the recurrence rate. Moreover, it does not increase the incidence rate of surgical complications.