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Agar N, Philippe AC, Bourdel N, Rabischong B, Canis M, Le Bouedec G, Mulliez A, Dauplat J, Pomel C. [Morbidity of pelvic lymphadenectomy and para-aortic lymphadenectomy in endometrial cancer]. Bull Cancer 2015; 102:428-35. [PMID: 25956349 DOI: 10.1016/j.bulcan.2015.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/04/2015] [Indexed: 10/23/2022]
Abstract
The aim of this study was to evaluate the complication rate of pelvic and para-aortic lymphadenectomy in the management of endometrial cancer following the changes to the recommendations of INCa 2010. This is a retrospective study of 208 patients operated for endometrial cancer between July 2010 and March 2014 in two referral centers. Eighty lymphadenectomy were performed, 65 with hysterectomy and bilateral annexectomy and 18 lymphadenectomy were performed for restaging. Complications assessment is based on the Dindo Clavien classification. We report 17 severe complications (grade 3a and over) (P<0.001), including 14 among patients receiving lymphadenectomy. Morbidity increases with the number of lymphnodes removed and their positivity (P<0.001). The para-aortic lymphadenectomy is primarily responsible for complications (P <0.001). We describe 7 lower limbs lymphedema, 12 nerve injuries, 8 ileus, 5 venous or arterial thromboembolism, 17 blood transfusions, 13 lymphoceles including 9 infected. The rate of intraoperative complications on a first lymphadenectomy is 8% while it reached 22% for restaging. Restaging is significantly more at risk of serious complications (P=0.03) with two deaths. Twenty-four chronic disorders with impaired quality of life (2 without lymphadenectomy) are reported. They are present in 50% of restaging (P=0.033 compared to first lymphadenectomy). Lymphadenectomy is a source of severe morbidity (17.5%) with 2.5% mortality. The benefit of this surgery should probably be discussed again.
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Affiliation(s)
- Nicolas Agar
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Anne-Cécile Philippe
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Nicolas Bourdel
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France
| | - Benoît Rabischong
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Michel Canis
- Hôpital Estaing, département de gynécologie obstétrique, 1, rue Lucie-Aubrac, 63100 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Guillaume Le Bouedec
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France
| | - Aurélien Mulliez
- Délégation recherche clinique et innovation, 58, rue Montalembert, 63003 Clermont-Ferrand cedex, France
| | - Jacques Dauplat
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France
| | - Christophe Pomel
- Centre Jean-Perrin, département de chirurgie cancérologique, 58, rue Montalembert, 63058 Clermont-Ferrand, France; Université d'Auvergne, France.
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