The role of complementary lymphadenectomy in patients with incidental endometrial cancer

Abstract Background: Up to 3.0% of women are diagnosed with endometrial cancer after hysterectomy for apparently benign conditions. There is controversy about the benefit of complementary lymphadenectomy in incidental endometrial cancer after histerectomy. Objective: To evaluate the role complementary lymphadenectomy during a second surgery in the prognosis of patients with endometrial carcinoma. Study design: This was a retrospective cohort study of patients who were diagnosed with endometrial carcinoma from 2005 to 2019. Two groups were evaluated: patients who underwent a second surgery involving pelvic and/or para-aortic lymphadenectomy and patients who did not undergo surgical lymph node evaluation. Logistic regression was used to identify the factors associated with whether or not a complementary lymphadenectomy was performed. The Kaplan–Meier method was used to generate survival curves, and the log-rank test was used for comparisons. Univariate and multivariate analyses were performed with the Cox test. Results: Two hundred and sixty patients were included. Among them, 120 (46.15%) underwent complementary lymphadenectomy, and 140 (53.83%) did not. The factors associated with performing complementary lymphadenectomy in a second surgical procedure were higher grade, nonendometrioid histology and deep myometrial involvement. The factors associated with adjuvant treatment were high-grade histology, deep myometrial involvement, cervical involvement and extensive lymphovascular permeation. Second-stage adjuvant lymphadenectomy was not associated with adjuvant treatment (OR 0.85 95% CI 0.35-2.02), overall survival (Hazard Ratio (HR) 0.40 95% CI 1.16-1.00) or disease-free survival (HR 0.77 95% CI 0.38-1.59). Conclusions: complementary lymphadenectomy during the second surgery in patients with endometrial cancer does not have a therapeutic or prognostic role but is associated with receiving adjuvant treatment. Individualizing each patient is important for deciding on a second surgical procedure.