Lymphadenectomy in endometrial cancer: when, not if.

摘要

The lack of consensus for primary surgical treatment of endometrial cancer, the most common gynaecological cancer, is deplorable. Whether lymphadenectomy should be done together with hysterectomy has been debated at length and passionately. Resolution of this problem has been confounded by several issues, such as selection of patients, the perceived goals of lymphadenectomy, and clinicians' failure to recognise the known routes of lymphatic spread from the uterus.1 In practice, lymphadenectomy varies from complete omission, to various iterations of lymph-node sampling, to systematic lymphadenectomy. Furthermore, the extent of lymphadenectomy ranges from pelvic-node dissection alone to dissection of the para-aortic area, which can include the aortic bifurcation to the inferior mesenteric artery and up to the renal vessels.