Hysterectomy With Pelvic and Paraaortic Lymphadenectomy

Endometrial cancer is the most common gynecologic malignancy in developed countries. Hysterectomy with bilateral salpingo-oophorectomy represents the mainstay of treatment. No data suggest that the route of hysterectomy influences oncologic outcomes (disease-free survival and overall survival) of this disease. Accordingly, minimally invasive surgery (robotic assisted and laparoscopic) is replacing abdominal surgery for endometrial cancer staging because of the lower morbidity and faster recovery associated with the former. However, the total abdominal approach has been the hallmark of therapy for endometrial cancer. Also, sentinel lymph nodes are rapidly becoming the new accepted procedure for endometrial cancer staging. However, when sentinel lymph nodes are not available or not feasible, pelvic lymphadenectomy (with or without paraaortic lymphadenectomy) has been shown to guarantee appropriate evaluation for patients with endometrial cancer at moderate and high risk of lymphatic metastasis. According to the traditional Mayo Clinic criteria, pelvic lymphadenectomy is required in patients with endometrioid endometrial cancer grade 3, or endometrioid endometrial cancer grade 1 or 2 with cervical stromal invasion, or endometrioid endometrial cancer grade 1 or 2 with primary tumor diameter greater than 2 cm. Paraaortic lymphadenectomy may be indicated in patients with type II (serous, clear cell, carcinosarcoma) endometrial cancer, myometrial invasion of 50% or more, or both, and every time a pelvic lymph node is revealed to be positive at frozen section analysis.