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Otsuka, I. Adjuvant Therapy in Endometrial Cancer. Encyclopedia. Available online: (accessed on 07 December 2023).
Otsuka I. Adjuvant Therapy in Endometrial Cancer. Encyclopedia. Available at: Accessed December 07, 2023.
Otsuka, Isao. "Adjuvant Therapy in Endometrial Cancer" Encyclopedia, (accessed December 07, 2023).
Otsuka, I.(2022, September 26). Adjuvant Therapy in Endometrial Cancer. In Encyclopedia.
Otsuka, Isao. "Adjuvant Therapy in Endometrial Cancer." Encyclopedia. Web. 26 September, 2022.
Adjuvant Therapy in Endometrial Cancer

Endometrial cancer is the most common gynecological tract malignancy in developed countries. Extrauterine disease, in particular lymph node metastasis, is an important prognostic factor. Lymphadenectomy may have a therapeutic benefit if adjuvant therapy can be omitted without decreasing oncological outcomes, as the long-term quality of life is maintained by avoiding morbidities associated with adjuvant therapy. In intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be safely omitted without decreasing long-term survival by open surgery including systematic pelvic and para-aortic lymphadenectomy when patients are node-negative.

endometrioid endometrial carcinoma systematic lymphadenectomy pelvic and para-aortic lymphadenectomy

1. Introduction

Endometrial cancer is the most common female genital tract malignancy in developed countries. Its incidence has been increasing globally because of rising obesity rates and longer life expectancy [1][2]. The majority of endometrial cancers are confined to the uterus, and patients with such diseases have a favorable prognosis. In contrast, patients with extrauterine disease, particularly lymph node metastasis, have a poorer survival. To assess lymph node status, lymphadenectomy or sentinel lymph node biopsy is performed. Lymphadenectomy has a diagnostic benefit by providing the knowledge of pathological lymph node status that is useful for tailoring the appropriate adjuvant therapy. However, pelvic lymphadenectomy has not been thought to have a therapeutic benefit, as it did not improve survival in two randomized controlled trials [3][4]. Thus, attempts have been made to reduce surgical morbidity of lymphadenectomy with the introduction of sentinel lymph node biopsy.
In contrast, attempts to reduce the use of adjuvant therapy in the management of endometrial cancer have been limited, although its effect on overall survival, similar to that of lymphadenectomy, has not been established [5][6][7][8][9]. In node-positive patient adjuvant therapy, radiation therapy and/or chemotherapy is given to eradicate residual diseases after surgery. However, even though lymph node metastasis is not detected by lymph node assessment, adjuvant therapy is recommended for patients with uterine-confined disease considered to be at risk of recurrence under current treatment guidelines [10][11][12].
Lymphadenectomy may have a therapeutic benefit in node-negative patients if adjuvant therapy can be omitted without decreasing oncological outcomes, because morbidities that decrease long-term quality of life of survivors associated with adjuvant therapy can be avoided [13][14][15][16][17][18][19]. In this research, I discuss the characteristics of lymph node metastasis in endometrial carcinoma, the methods of lymph node assessment, and the possibility of omitting adjuvant therapy in patients with node-negative uterine-confined endometrioid carcinoma who undergo systematic lymphadenectomy.

2. Role of Adjuvant Therapy in Endometrial Cancer

There is no definitive evidence that adjuvant therapy improves the long-term survival of women with endometrial cancer apparently confined to the uterus. Randomized controlled trials have shown that external beam radiotherapy to the pelvis decreases local recurrence but does not improve overall survival [5][6][7]. Although external beam radiotherapy might improve survival in patients with high-intermediate risk disease [6], a meta-analysis indicated that in intermediate- and high-risk patients, adjuvant external beam radiotherapy did not improve overall survival [20]. In intermediate-risk disease, adjuvant vaginal brachytherapy is recommended to avoid gastrointestinal complications that are often associated with external beam radiotherapy [10][11][12][21]. In node-negative patients with deeply invasive grade 3 endometrioid tumors, no survival benefit was observed with pelvic radiation compared to vaginal brachytherapy alone [22]. However, the necessity of adjuvant vaginal brachytherapy is questioned, because most vaginal recurrences can be cured with salvage therapy [23][24][25].
Adjuvant chemotherapy in patients with high-risk stage I–II endometrioid carcinoma improved survival in one study [26], but did not in another study [27]. In high-intermediate and high-risk early-stage endometrial carcinoma, pelvic and para-aortic nodal recurrences were more common after chemotherapy and vaginal brachytherapy compared to pelvic radiation therapy [28]. Effects of chemotherapy may be limited in grade 3 tumors [29][30].
Late complications caused by adjuvant therapy may reduce the long-term quality of life of survivors. After external beam radiotherapy, gastrointestinal complications may lead to limitations in daily activities [21]. In particular, pelvic radiotherapy following surgery including lymphadenectomy significantly increased risk of serious complications compared to surgery alone [6]. Vaginal brachytherapy may cause vaginal atrophy and subsequent stenosis [17] and severe bowel complications such as rectal bleeding [16]. Chemotherapy including platinum and/or taxane often causes peripheral neuropathy that decreases quality of life [18][19].
Importantly, adjuvant therapy might not replace surgical removal as a treatment for positive nodes in some patients, as patients who underwent lymphadenectomy had an improved survival compared to those who did not undergo the procedure, even though adjuvant therapy was performed [31][32][33][34].
Theoretically, adjuvant therapy is not necessary for patients with node-negative uterine-confined disease, because residual diseases that otherwise need to be eradicated by adjuvant therapy are not left behind. Patients with clinically negative but histologically positive nodes can also become disease-free by both lymphadenectomy and/or sentinel lymph node biopsy followed by lymphadenectomy.

3. Sentinel Node-Negative Patients: Can Adjuvant Therapy Be Omitted?

Sentinel lymph node mapping has been increasingly performed instead of lymphadenectomy that may be associated with surgical morbidities and sequelae, such as vascular injury and lymphedema [35][36]. The sentinel lymph node is defined as the first node in the lymphatic basin that receives drainage from the primary tumor. If the sentinel lymph node is negative, a regional lymphadenectomy can be avoided [37]. In breast cancer and melanoma, both of which are superficial cancers with less complicated lymphatic drainage routes, the sentinel lymph node technique has been incorporated into standard practice [38][39]. In endometrial cancer, sentinel lymph node mapping has a high degree of diagnostic accuracy and detects low-volume metastasis in the sentinel nodes [40][41][42][43][44].
However, in intermediate- and high-risk endometrial cancers, the detection of the true sentinel nodes by the standard method, cervical injection of a tracer, may be difficult. Whereas low-risk diseases metastasize almost only to pelvic nodes, intermediate- and high-risk diseases metastasize to not only pelvic nodes, but also para-aortic nodes. The lymphatic network draining the uterus is complex and involves both pelvic and para-aortic nodes [45], as lymphatic channels draining from the uterine fundus course into the broad ligament and along the ovarian vessels [45][46]. The incidence of isolated para-aortic node metastasis (without pelvic node metastasis) in patients with intermediate- and high-risk diseases ranges from 2.6 to 3.1% [47][48][49], and the majority of para-aortic node metastases are observed above the inferior mesenteric artery [50]. Cervical injection is superior in detecting pelvic sentinel nodes [51] and achieves a higher sentinel node detection rate than fundal injection [52][53]. However, hysteroscopic or ultrasound-guided fundal sub-endometrial injection is necessary to detect para-aortic sentinel nodes [53][54][55][56][57][58].
Histopathological detection of metastatic lesions in the sentinel lymph nodes may be difficult during surgery. As a lymph node metastasis less than 2 mm was often missed at frozen section examination [59], ultrastaging is necessary to detect the majority of low-volume metastases in the sentinel nodes that account for 25–48% of sentinel node metastasis [40][60][61][62][63]. Many studies testing the sensitivity of sentinel lymph nodes have reported high sensitivity; however, in most studies, pathological evaluation of sentinel nodes was performed after back-up lymphadenectomy following sentinel lymph node biopsy [42][44][52][60][64][65][66][67].
Most importantly, negative sentinel nodes may lead to the omission of lymphadenectomy, but may not necessarily lead to the omission of adjuvant therapy. A false negative rate of 15% has been reported with a blue dye cervical injection [68]. Current studies on sentinel lymph node mapping were aimed at the accurate detection of metastatic lymph nodes by performing back-up lymphadenectomy; thus, lymphadenectomy was rarely omitted [42][44][52][60][64][65][66][67]. Adjuvant therapy was given even in patients with node-negative uterine-confined disease when they were considered to be at risk of recurrence based on uterine pathological factors [69][70]. In node-negative deeply invasive endometrioid carcinoma, patients who underwent sentinel lymph node mapping were more likely to receive adjuvant therapy than patients who underwent lymphadenectomy [71]. A previous study reported that of 54 sentinel node-negative patients treated with adjuvant therapy, eight (15%) developed recurrence [64]. If adjuvant therapy is given according to uterine pathological factors irrespective of nodal status, sentinel lymph node mapping, which significantly increases the costs compared to hysterectomy alone [36], might not be necessary. To evaluate the efficacy of sentinel lymph node biopsy, prospective studies evaluating the long-term oncologic outcome are necessary [72], particularly the long-term safety of omitting both systematic lymphadenectomy and adjuvant therapy in sentinel node-negative patients. Long-term follow-up is indispensable to detect lymph node recurrence, because it often develops five years or later [73].

4. Benefit of Systematic Lymphadenectomy in Node-Negative Patients: Omission of Adjuvant Therapy

For an accurate evaluation of the therapeutic effects of lymphadenectomy, appropriate patients need to undergo appropriate surgery, as selection of appropriate patients is necessary to detect survival difference between patients who undergo lymphadenectomy and those who do not. First, patients at low-risk for lymph node metastasis need to be excluded [74][75][76]. In these patients, the incidence of lymph node metastasis is at most 5.9%, when considering low-volume metastasis [61]; thus, survival difference cannot be detected without a sufficient power. It is plausible that effects of lymphadenectomy on survival cannot be detected in randomized trials, considering the rate of low-risk disease in endometrioid endometrial carcinoma [3][4][77][78]. Second, patients with high-risk histological subtypes, i.e., serous carcinoma and carcinosarcoma, also need to be excluded, as they often develop peritoneal and hematogenous spread independent of lymph node metastasis [79][80][81].
In intermediate- or high-risk endometrioid carcinomas, systematic lymphadenectomy, particularly pelvic with para-aortic lymphadenectomy, appears to improve survival [33][82][83][84][85][86][87]. Incidences of lymph node metastasis in intermediate- and high-risk endometrioid carcinomas were 17% and 25%, respectively, in the previous study [47]. These incidences may be underestimated, and when ultrastaging was performed, the incidence of lymph node metastasis in high-intermediate risk endometrioid endometrial carcinoma was 24–43% [88][89].
Additionally, for lymphadenectomy to have a therapeutic benefit, no positive lymph nodes are left behind at the completion of surgery. Namely, it is necessary to remove lymph nodes bearing not only macroscopic but also low-volume metastases. Moreover, lymph nodes in the para-aortic region as well as those in the pelvic region need to be removed in intermediate- and high-risk endometrial carcinoma when deep myometrial invasion is observed [90].
However, the procedures performed during lymphadenectomy range from a mere sampling of enlarged or suspicious lymph nodes for staging purposes to systematic removal of all accessible lymphatic tissue with a therapeutic intent [75]. Systematic complete lymphadenectomy is performed to remove enlarged nodes and to skeletonize the vessels of node-bearing tissue [75][91]. The number of nodes removed varies among studies: the median numbers of nodes removed in the pelvic and para-aortic region were in the ranges of 11–54 and 5–23, respectively [47][48][82][84][85][90][92]. The quality of surgical resection may be measured by a nodal count that is indicative of the extent of nodal dissection, although the number of nodes reported by the pathologist depends on surgical expertise, the comprehensiveness of pathological analysis, and anatomical variations in patients [75]. The removal of 10 or more regional lymph nodes was associated with improved survival in intermediate- and high-risk endometrioid carcinomas [31][32][93]. The number of nodal stations sampled may be a more accurate predictor of lymph node metastasis than lymph node count [94][95].
The number of nodes removed is associated with improved survival also in patients with other cancers, i.e., breast, lung, and cervical cancers, even when all regional lymph nodes are interpreted as pathologically negative [96][97][98][99]. In particular, with the removal of larger numbers of nodes, regional relapse was significantly decreased for breast cancer patients not receiving systemic therapy [97].
Node-negative patients consist of true node-negative and false node-negative patients. False node-negative patients have occult lymph node metastasis that cannot be detected by standard pathological evaluation or that cannot be removed by non-systematic lymphadenectomy.
Systematic lymphadenectomy can remove all lymph nodes bearing macroscopic and low-volume metastases, as patients with endometrioid carcinoma who undergo systematic lymphadenectomy rarely develop lymph node recurrence, even without adjuvant therapy [47][91][100][101][102]. Similarly, nodal recurrences were rare in patients who underwent systematic lymphadenectomy with subsequent vaginal brachytherapy alone [92][103][104][105].
More importantly, in intermediate- and high-risk endometrioid endometrial carcinomas, adjuvant therapy may be omitted without decreasing survival by open surgery with systematic pelvic and para-aortic lymphadenectomy when patients are node-negative (Table 1) [47][100][101][102]. In the prospective cohort study of 77 node-negative patients with intermediate- and high-risk endometrioid carcinoma, only two understaged high-risk patients died of disease [47]. Although hematogenous spread (pulmonary metastasis is most commonly observed) may develop in endometrioid carcinoma, its risk is low in patients without extrauterine diseases [106][107]. Thus node-negative patients undergoing systematic lymphadenectomy that can remove all lymph nodes including positive nodes containing undetectable low-volume metastasis may be considered to be true node-negative. In contrast, sentinel node-negative patients without back-up lymphadenectomy might have a higher possibility of having undetected residual lymph node metastasis at the completion of surgery. Of note, in patients with positive peritoneal cytology, adjuvant therapy may not be omitted, as positive peritoneal cytology in low-stage disease was associated with decreased survival [108].
Table 1. Long-term outcomes of patients with intermediate- and high-risk endometrial carcinoma treated with open surgery alone, including pelvic and para-aortic lymphadenectomy.
Node-positive patients, in particular patients with low-volume metastasis, can be cured with surgery alone including systematic lymphadenectomy. A previous study has reported that five-year overall survival was 40% for node-positive patients treated with surgery alone [109]. Researchers have experienced the long-term survival of a case with grade 3 endometrioid endometrial carcinoma with para-aortic node metastasis treated with surgery alone [110]. She had a pelvic node, a para-aortic node, and an adnexal metastasis, but all metastatic diseases were micrometastasis (<2 mm). Similarly, isolated tumor cells detected in removed sentinel nodes may not decrease survival, even without adjuvant therapy [111][112][113][114].
The patient age, which has been incorporated into the existing risk classification systems [5][6], may influence the effect of lymphadenectomy in endometrioid endometrial carcinoma (Table 2). In elderly women, lymphadenectomy may be less effective than in younger women, which might be indicated in German population-based studies where median age of the patients was 69 years or older [115][116]. This may be explained by the association of older age with adverse pathologic features [117][118], hematogenous dissemination [106], and immunosenescence [119]. Otherwise, the route of surgical approach, which was not described in some recent studies, might affect the results.
Table 2. Effects of pelvic and para-aortic lymphadenectomy by age.
Author (Year) No. of Patients Lymphadenectomy Number of Nodes Removed Age Tumor Type
Positive effects of PLA/PALA on survival      
Huang (2013) [86] 961 PLA, PALA 18 (pelvic) 5 (para-aortic) 53 y, median Endometrioid
Todo (2010) [85] 671 PLA, PALA 59 (pelvic) 23 (para-aortic) 56 y, median Other than low-risk (pT1A, G1-2)
Abu-Rustum (2008) [94] 1035 PLA, PALS (up to IMA) 16 61 y, median Endometrioid
Mariani (2000) [82] 137 PLA, PALA 16 (pelvic) 6 (para-aortic) 67 y, mean Patients at high risk for para-aortic lymph node involvement *
Eggemann (2016) [87] 1502 PLA, PALA 19 66 y (PLA and PALA) 68 y (PLA) 72 y (no LA), mean Other than low-risk (pT1A, G1-2)
No effects of PLA/PALA on survival      
Papathemelis (2018) [117] 299 PLA, (PALA) 26 69 y, median pT1B G1-2, type I
Ignatov (2020) [116] 2392 PLA, PALA 29 69 y (LA) 74 y (no LA), median Endometrioid, intermediate-risk (pT1A G3, pT1B G1-2) high-risk (pT1B G3, pT2 Gany)
PLA, pelvic lymphadenectomy; PALA, para-aortic lymphadenectomy; PALS, para-aortic lymph node sampling; IMA, inferior mesenteric artery; NA, not available. * Myometrial invasion >50%, macroscopically positive pelvic nodes or positive adnexae, excluding stage IV disease.


  1. Crosbie, E.J.; Kitson, S.J.; McAlpine, J.N.; Mukhopadhyay, A.; Powell, M.E.; Singh, N. Endometrial cancer. Lancet 2022, 399, 1412–1428.
  2. Lu, K.H.; Broaddus, R.R. Endometrial Cancer. N. Engl. J. Med. 2020, 383, 2053–2064.
  3. Benedetti Panici, P.; Basile, S.; Maneschi, F.; Lissoni, A.A.; Signorelli, M.; Scambia, G.; Angioli, R.; Tateo, S.; Mangili, G.; Katsaros, D.; et al. Systematic pelvic lymphadenectomy vs no lymphadenectomy in early-stage endometrial carcinoma: Randomized clinical trial. J. Natl. Cancer Inst. 2008, 100, 1707–1716.
  4. Kitchener, H.; Swart, A.M.C.; Qian, Q.; Amos, C.; Parmar, M.K.B. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): A randomised study. Lancet 2009, 373, 125–136.
  5. Creutzberg, C.L.; van Putten, W.L.J.; Koper, P.C.M.; Lybeert, M.L.M.; Jobsen, J.J.; Warlam-Rodenhuis, C.C.; De Winter, K.A.; Lutgens, L.C.; van den Bergh, A.C.; van de Steen-Banasik, E.; et al. Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: Multicentre random trial. Lancet 2000, 355, 1404–1411.
  6. Keys, H.M.; Roberts, J.A.; Brunetto, V.L.; Zaino, R.J.; Spirtos, N.M.; Bloss, J.D.; Pearlman, A.; Maiman, M.A.; Bell, J.G. A phase III trial of surgery with or without adjunctive external pelvic radiation therapy in intermediate risk endometrial adenocarcinoma: A Gynecologic Oncology Group study. Gynecol. Oncol. 2004, 92, 744–751.
  7. Onsrud, M.; Cvancarova, M.; Hellebust, T.P.; Trope, C.G.; Kristensen, G.B.; Lindemann, K. Long-term outcomes after pelvic radiation for early-stage endometrial cancer. J. Clin. Oncol. 2013, 31, 3951–3956.
  8. Maggi, R.; Lissoni, A.; Spina, F.; Melpignano, M.; Zola, P.; Favalli, G.; Colombo, A.; Fossati, R. Adjuvant chemotherapy vs. radiotherapy in high-risk endometrial carcinoma: Results of a randomised trial. Br. J. Cancer 2006, 95, 266–271.
  9. Susumu, N.; Sagae, S.; Udagawa, Y.; Niwa, K.; Kuramoto, H.; Satoh, S.; Kudo, R. Randomized phase III trial of pelvic radiotherapy versus cisplatin-based combined chemotherapy in patients with intermediate- and high-risk endometrial cancer: A Japanese Gynecologic Oncology Group study. Gynecol. Oncol. 2008, 108, 226–233.
  10. Ebina, Y.; Katabuchi, H.; Mikami, M.; Nagase, S.; Yaegashi, N.; Udagawa, Y.; Kato, H.; Kubushiro, K.; Takamatsu, K.; Ino, K.; et al. Japan Society of Gynecologic Oncology guidelines 2013 for the treatment of uterine body neoplasms. Int. J. Clin. Oncol. 2016, 21, 419–434.
  11. Colombo, N.; Preti, E.; Landoni, F.; Carinelli, S.; Colombo, A.; Marini, C.; Sessa, C. ESMO Guidelines Working Group (2013) Endometrial cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2013, 24 (Suppl. S6), vi33–vi38.
  12. Concin, N.; Matias-Guiu, X.; Vergote, I.; Cibula, D.; Mirza, M.R.; Marnitz, S.; Ledermann, J.; Bosse, T.; Chargari, C.; Fagotti, A.; et al. ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma. Int. J. Gynecol. Cancer 2021, 31, 12–39.
  13. Corn, B.W.; Lanciano, R.M.; Greven, K.M.; Noumoff, J.; Schultz, D.; Hanks, G.E.; Fowble, B.L. Impact of improved irradiation technique, age, and lymph node sampling on the severe complication rate of surgically staged endometrial cancer patients: A multivariate analysis. J. Clin. Oncol. 1994, 12, 510–515.
  14. Nout, R.A.; Putter, H.; Jürgenliemk-Schulz, I.M.; Jobsen, J.J.; Lutgens, L.C.H.W.; Van Der Steen-Banasik, E.M.; Mens, J.W.M.; Slot, A.; Kroese, M.C.S.; Nijman, H.W.; et al. Five-year quality of life of endometrial cancer patients treated in the randomized Post Operative Radiation Therapy in Endometrial Cancer (PORTEC-2) trial and comparison with norm data. Eur. J. Cancer 2012, 48, 1638–1648.
  15. van de Poll-Franse, L.V.; Pijnenborg, J.M.A.; Boll, D.; Vos, M.C.; van den Berg, H.; Lybeert, M.L.M.; de Winter, K.; Kruitwagen, R.F.P.M. Health related quality of life and symptoms after pelvic lymphadenectomy or radiotherapy vs. no adjuvant regional treatment in early-stage endometrial carcinoma: A large population-based study. Gynecol. Oncol. 2012, 127, 153–160.
  16. Pellizzon, A.C.A.; Fogarolli, R.C.; Miziara, M.; Baraldi, H.; Soares, C.R. Morbidity of adjuvant high-dose-rate brachytherapy for low to intermediate risk endometrial adenocarcinoma completely resected. Int. J. Cancer 2001, 96, 105–108.
  17. Harkenrider, M.M.; Block, A.M.; Siddiqui, Z.A.; Small, W., Jr. The role of vaginal cuff brachytherapy in endometrial cancer. Gynecol. Oncol. 2015, 136, 365–372.
  18. Cella, D.; Huang, H.; Homesley, H.D.; Montag, A.; Salani, R.; De Geest, K.; Lee, R.; Spirtos, N.M. Patient-reported peripheral neuropathy of doxorubicin and cisplatin with and without paclitaxel in the treatment of advanced endometrial cancer: Results from GOG 184. Gynecol. Oncol. 2010, 119, 538–542.
  19. Forsse, D.; Barbero, M.L.; Werner, H.M.J.; Woie, K.; Nordskar, N.; Nielsen, E.B.; Engh, M.E.; Vistad, I.; Rege, A.; Sævik-Lode, M.; et al. Longitudinal effects of adjuvant chemotherapy and lymph node staging on patient-reported outcomes in endometrial cancer survivors: A prospective cohort study. Am. J. Obstet. Gynecol. 2022, 226, 90.e1–90.e20.
  20. Blake, P.; Swart, A.M.; Orton, J.; Kitchener, H.; Whelan, T.; Lukka, H.; Eisenhauer, E.; Bacon, M.; Tu, D.; Parmar, M.K.B.; et al. The ASTEC/EN.5 writing committee on behalf of the ASTEC/EN.5 Study Group. Adjuvant external beam radiotherapy in the treatment of endometrial cancer (MRC ASTEC and NCIC CTG EN.5 randomised trials): Pooled trial results, systematic review, and meta-analysis. Lancet 2009, 373, 137–146.
  21. Nout, R.A.; van de Poll-Francse, L.V.; Lybeert, M.L.M.; Warlam-Rodenhuis, C.C.; Jobsen, J.J.; Mens, J.W.M.; Lutgens, L.C.H.W.; Pras, B.; van Putten, W.L.J.; Creutzberg, C.L. Long-term outcome and quality of life of patients with endometrial carcinoma treated with or without pelvic radiotherapy in the Post Operative Radiation Therapy in Endometrial Carcinoma 1 (PORTEC-1) trial. J. Clin. Oncol. 2011, 29, 1692–1700.
  22. Onstad, M.; Ducie, J.; Fellman, B.M.; Abu-Rustum, N.R.; Leitao, M.; Mariani, A.; Multinu, F.; Lu, K.H.; Soliman, P. Adjuvant therapy for grade 3, deeply invasive endometrioid adenocarcinoma of the uterus. Int. J. Gynecol. Cancer 2020, 30, 485–490.
  23. Creutzberg, C.L.; van Putten, W.L.J.; Koper, P.C.; Lybeert, M.L.M.; Jobsen, J.J.; Wárlám-Rodenhius, C.C.; De Winter, K.A.L.; Lutgens, L.C.H.W.; van den Bergh, A.C.M.; van den Steen-Banasik, E.; et al. Survival after relapse in patients with endometrial cancer: Results from a randomized trial. Gynecol. Oncol. 2003, 89, 201–209.
  24. Petignat, P.; Jolicoeur, M.; Alobaid, A.; Drouin, P.; Gauthier, P.; Provencher, D.; Donath, D.; Nguyen, T.V. Salvage treatment with high-dose-rate brachytherapy for isolated vaginal endometrial cancer recurrence. Gynecol. Oncol. 2006, 101, 445–449.
  25. Otsuka, I.; Uno, M.; Wakabayashi, A.; Kameda, S.; Udagawa, H.; Kubota, T. Predictive factors for prolonged survival in recurrent endometrial carcinoma: Implications for follow-up protocol. Gynecol. Oncol. 2010, 119, 506–510.
  26. Aoki, Y.; Watanabe, M.; Amikura, T.; Obata, H.; Sekine, M.; Yahata, T.; Fujita, K.; Tanaka, K. Adjuvant chemotherapy as treatment of high-risk stage I and II endometrial cancer. Gynecol. Oncol. 2004, 94, 333–339.
  27. Multinu, F.; Garzon, S.; Weaver, A.L.; McGree, M.E.; Sartori, E.; Landoni, F.; Zola, P.; Dinoi, G.; Aletti, G.; Block, M.S.; et al. Adjuvant Chemotherapy in Early Stage Endometrioid Endometrial Cancer with >50% Myometrial Invasion and Negative Lymph Nodes. Int. J. Gynecol. Cancer 2021, 31, 537–544.
  28. Randall, M.E.; Filiaci, V.; McMeekin, D.S.; von Gruenigen, V.; Huang, H.; Yashar, C.M.; Mannel, R.S.; Kim, J.W.; Salani, R.; DiSilvestro, P.A.; et al. Phase III Trial: Adjuvant Pelvic Radiation Therapy Versus Vaginal Brachytherapy Plus Paclitaxel/Carboplatin in High-Intermediate and High-Risk Early Stage Endometrial Cancer. J. Clin. Oncol. 2019, 37, 1810–1818.
  29. Fujimoto, T.; Nanjyo, H.; Fukuda, J.; Nakamura, A.; Mizunuma, H.; Yaegashi, N.; Sugiyama, T.; Kurachi, H.; Sato, A.; Tanaka, T. Endometrioid uterine cancer: Histopathological risk factors of local and distant recurrence. Gynecol. Oncol. 2009, 112, 342–347.
  30. Bakkum-Gamez, J.N.; Mariani, A.; Dowdy, S.C.; Weaver, A.L.; McGree, M.E.; Martin, J.R.; Keeney, G.L.; Jatoi, A.; Gostout, B.S.; Podratz, K.C. Efficacy of contemporary chemotherapy in stage IIIC endometrial cancer: A histologic dichotomy. Gynecol. Oncol. 2014, 132, 578–584.
  31. Cragun, J.M.; Havrilesky, L.J.; Calingaert, B.; Synan, I.; Secord, A.A.; Soper, J.T.; Clarke-Pearson, D.L.; Berchuck, A. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J. Clin. Oncol. 2005, 23, 3668–3675.
  32. Chan, J.K.; Cheung, M.K.; Huh, W.K.; Osann, K.; Husain, A.; Teng, N.N.; Kapp, D.S. Therapeutic role of lymph node resection in endometrioid corpus cancer. A study of 12,333 patients. Cancer 2006, 107, 1823–1830.
  33. Jeong, N.H.; Lee, J.M.; Lee, J.K.; Kim, M.K.; Kim, Y.J.; Cho, C.H.; Kim, S.M.; Park, S.Y.; Park, C.Y.; Kim, K.T. Role of systematic lymphadenectomy and adjuvant radiation in early-stage endometrioid uterine cancer. Ann. Surg. Oncol. 2010, 17, 2951–2957.
  34. Todo, Y.; Kato, H.; Minobe, S.; Okamoto, K.; Suzuki, Y.; Sudo, S.; Takeda, M.; Watari, H.; Kaneuchi, M.; Sakuragi, N. Initial failure site according to primary treatment with or without para-aortic lymphadenectomy in endometrial cancer. Gynecol. Oncol. 2011, 121, 314–318.
  35. Leitao, M.M., Jr.; Zhou, Q.C.; Gomez-Hidalgo, N.R.; Iasonos, A.; Baser, R.; Mezzancello, M.; Chang, K.; Ward, J.; Chi, D.S.; Roche, K.L.; et al. Patient-reported outcomes after surgery for endometrial carcinoma: Prevalence of lower-extremity lymphedema after sentinel lymph node mapping versus lymphadenectomy. Gynecol. Oncol. 2020, 156, 147–153.
  36. Dioun, S.; Chen, L.; Melamed, A.; Gockley, A.; St Clair, C.M.; Hou, J.Y.; Khoury-Collado, F.; Hershman, D.L.; Wright, J.D. Uptake and outcomes of sentinel lymph node mapping in women undergoing minimally invasive surgery for endometrial cancer. BJOG 2022, 129, 1591–1599.
  37. Frimer, M.; Khoury-Collado, F.; Murray, M.P.; Barakat, R.R.; Abu-Rustum, N.R. Micrometastases of endometrial cancer to sentinel lymph nodes: Is it an artifact of uterine manipulation? Gynecol. Oncol. 2010, 119, 496–499.
  38. Nottegar, A.; Veronese, N.; Senthil, M.; Roumen, R.M.; Stubbs, B.; Choi, A.H.; Verheuvel, N.C.; Solmi, M.; Pea, A.; Capelli, P.; et al. Extra-nodal extension of sentinel lymph node metastasis is a marker of poor prognosis in breast cancer patients: A systematic review and an exploratory meta-analysis. Eur. J. Surg. Oncol. 2016, 42, 919–925.
  39. Faries, M.B.; Thompson, J.F.; Cochran, A.J.; Andtbacka, R.H.; Mozzillo, N.; Zager, J.S.; Jahkola, T.; Bowles, T.L.; Testori, A.; Beitsch, P.D.; et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N. Engl. J. Med. 2017, 376, 2211–2222.
  40. Khoury-Collado, F.; Murray, M.P.; Hensley, M.L.; Sonoda, Y.; Alektiar, K.M.; Levine, D.A.; Chi, D.S.; Barakat, R.R.; Abu-Rustum, N.R. Sentinel lymph node mapping for endometrial cancer improves the detection of metastatic disease to regional lymph nodes. Gynecol. Oncol. 2011, 122, 251–254.
  41. Ballester, M.; Naoura, I.; Chéreau, E.; Seror, J.; Bats, A.S.; Bricou, A.; Daraï, E. Sentinel node biopsy upstages patients with presumed low- and intermediate-risk endometrial cancer: Results of a multicenter study. Ann. Surg. Oncol. 2013, 20, 407–412.
  42. Rossi, E.C.; Kowalski, L.D.; Scalici, J.; Cantrell, L.; Schuler, K.; Hanna, R.K.; Method, M.; Ade, M.; Ivanova, A.; Boggess, J.F. A comparison of sentinel lymph node biopsy to lymphadenectomy for endometrial cancer staging (FIRES trial): A multicentre, prospective, cohort study. Lancet Oncol. 2017, 18, 384–392.
  43. Bodurtha Smith, A.J.; Fader, A.N.; Tanner, E.J. Sentinel lymph node assessment in endometrial cancer: A systematic review and meta-analysis. Am. J. Obstet. Gynecol. 2017, 216, 459–476.
  44. Holloway, R.W.; Gupta, S.; Stavitzski, N.M.; Zhu, X.; Takimoto, E.L.; Gubbi, A.; Bigsby, G.E.; Brudie, L.A.; Kendrick, J.E.; Ahmad, S. Sentinel lymph node mapping with staging lymphadenectomy for patients with endometrial cancer increases the detection of metastasis. Gynecol. Oncol. 2016, 141, 206–210.
  45. Burke, T.W.; Levenback, C.; Tornos, C.; Morris, M.; Wharton, J.T.; Gershenson, D.M. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: Results of a pilot study. Gynecol. Oncol. 1996, 62, 169–173.
  46. Frumovitz, M.; Coleman, R.C.; Soliman, P.T.; Ramirez, P.T.; Levenback, C.F. A case for caution in the pursuit of the sentinel node in women with endometrial carcinoma. Gynecol. Oncol. 2014, 132, 275–279.
  47. Otsuka, I.; Matsuura, T.; Mitani, T.; Otsuka, K.; Kanamoto, Y. Open surgery including lymphadenectomy without adjuvant therapy for uterine-confined intermediate- and high-risk endometrioid endometrial carcinoma. Curr. Oncol. 2022, 29, 298.
  48. Fotopoulou, C.; El-Balat, A.; du Bois, A.; Sehouli, J.; Harter, P.; Muallem, M.Z.; Krätschell, R.W.; Traut, A.; Heitz, F. Systematic pelvic and paraaortic lymphadenectomy in early high-risk or advanced endometrial cancer. Arch. Gynecol. Obstet. 2015, 292, 1321–1327.
  49. Kumar, S.; Podratz, K.C.; Bakkum-Gamez, J.N.; Dowdy, S.C.; Weaver, A.L.; McGree, M.E.; Cliby, W.A.; Keeney, G.L.; Thomas, G.; Mariani, A. Prospective assessment of the prevalence of pelvic, paraaortic and high paraaortic lymph node metastasis in endometrial cancer. Gynecol. Oncol. 2014, 132, 38–43.
  50. Mariani, A.; Dowdy, S.C.; Cliby, W.A.; Gostout, B.S.; Jones, M.B.; Wilson, T.O.; Podratz, K.C. Prospective assessment of lymphatic dissemination in endometrial cancer: A paradigm shift in surgical staging. Gynecol. Oncol. 2008, 109, 11–18.
  51. Ditto, A.; Casarin, J.; Pinelli, C.; Perrone, A.M.; Scollo, P.; Martinelli, F.; Bogani, G.; Maggiore, U.L.R.; Signorelli, M.; Chiappa, V.; et al. Hysteroscopic versus cervical injection for sentinel node detection in endometrial cancer: A multicenter prospective randomised controlled trial from the Multicenter Italian Trials in Ovarian cancer (MITO) study group. Eur. J. Cancer 2020, 140, 1–10.
  52. Persson, J.; Salehi, S.; Bollino, M.; Lonnerfors, C.; Falconer, H.; Geppert, B. Pelvic Sentinel lymph node detection in High-Risk Endometrial Cancer (SHREC-trial)--the final step towards a paradigm shift in surgical staging. Eur. J. Cancer 2019, 116, 77–85.
  53. Perrone, A.M.; Casadio, P.; Formelli, G.; Levorato, M.; Ghi, T.; Costa, S.; Meriggiola, M.C.; Pelusi, G. Cervical and hysteroscopic injection for identification of sentinel lymph node in endometrial cancer. Gynecol. Oncol. 2008, 111, 62–67.
  54. Kataoka, F.; Susumu, N.; Yamagami, W.; Kuwahata, M.; Takigawa, A.; Nomura, H.; Takeuchi, H.; Nakahara, T.; Kameyama, K.; Aoki, D. The importance of para-aortic lymph nodes in sentinel lymph node mapping for endometrial cancer by using hysteroscopic radio-isotope tracer injection combined with subserosal dye injection: Prospective study. Gynecol. Oncol. 2016, 140, 400–404.
  55. Martinelli, F.; Ditto, A.; Signorelli, M.; Bogani, G.; Chiappa, V.; Lorusso, D.; Scaffa, C.; Recalcati, D.; Perotto, S.; Haeusler, E.; et al. Sentinel node mapping in endometrial cancer following Hysteroscopic injection of tracers: A single center evaluation over 200 cases. Gynecol. Oncol. 2017, 146, 525–530.
  56. Angeles, M.A.; Migliorelli, F.; Vidal-Sicart, S.; Saco, A.; Ordi, J.; Ros, C.; Fuste, P.; Munmany, M.; Escura, S.; Carreras, N.; et al. Paraaortic sentinel lymph node detection in intermediate and high-risk endometrial cancer by transvaginal ultrasound-guided myometrial injection of radiotracer (TUMIR). J. Gynecol. Oncol. 2021, 32, e52.
  57. Altın, D.; Taşkın, S.; Ortac, F.; Tokgozoğlu, N.; Vatansever, D.; Güler, A.H.; Güng, M.; Taşci, T.; Beşe, T.; Turan, H.; et al. Diagnostic accuracy of sentinel node biopsy in non-endometrioid, high-grade and/or deep myoinvasive endometrial cancer: A Turkish gynecologic oncology group study (TRSGO-SLN-006). Gynecol. Oncol. 2022, 164, 492–497.
  58. Niikura, H.; Okamura, C.; Utsunomiya, H.; Yoshinaga, K.; Akahira, J.; Ito, K.; Yaegashi, N. Sentinel lymph node detection in patients with endometrial cancer. Gynecol. Oncol. 2004, 92, 669–674.
  59. Pristauz, G.; Bader, A.A.; Regitnig, P.; Haas, J.; Winter, R.; Tamussino, K. How accurate is frozen section histology of pelvic lymph nodes in patients with endometrial cancer? Gynecol. Oncol. 2009, 115, 12–17.
  60. Ballester, M.; Dubernard, G.; Lecuru, F.; Heitz, D.; Mathevet, P.; Marret, H.; Querleu, D.; Golfier, F.; Leblanc, E.; Rouzier, R.; et al. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: A prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011, 12, 469–476.
  61. Kim, C.H.; Khoury-Collado, F.; Barber, E.L.; Soslow, R.A.; Makker, V.; Leitao, M.M., Jr.; Sonoda, Y.; Alektiar, K.M.; Barakat, R.R.; Abu-Rustum, N. Sentinel lymph node mapping with pathologic ultrastaging: A valuable tool for assessing nodal metastasis in low-grade endometrial cancer with superficial myoinvasion. Gynecol. Oncol. 2013, 131, 714–719.
  62. Baiocchi, G.; Mantoan, H.; Goncalves, B.T.; Faloppa, C.C.; Kumagai, L.Y.; Badiglian-Filho, L.; da Costa, A.A.B.A.; De Brot, L. Size of Sentinel Node Metastasis Predicts Non-sentinel Node Involvement in Endometrial Cancer. Ann. Surg. Oncol. 2020, 27, 1589–1594.
  63. Bogani, G.; Casarin, J.; Maggiore, U.L.R.; Ditto, A.; Pinelli, C.; Dell’acqua, A.; Lopez, S.; Chiappa, V.; Brusadelli, C.; Guerrisi, R.; et al. Survival outcomes in endometrial cancer patients having lymphadenectomy, sentinel node mapping followed by lymphadectomy and sentinel node mapping alone: Long-term results of a propensity-matched analysis. Gynecol. Oncol. 2020, 158, 77–83.
  64. Daraï, E.; Dubernard, G.; Bats, A.S.; Heitz, D.; Mathevet, P.; Marret, H.; Querleu, D.; Glfoier, F.; Leblanc, E.; Rouzier, R.; et al. Sentinel node biopsy for the management of early stage endometrial cancer: Long-term results of the SENTI-ENDO study. Gynecol. Oncol. 2015, 136, 54–59.
  65. Cusimano, M.C.; Vicus, D.; Pulman, K.; Maganti, M.; Bernardini, M.Q.; Bouchard-Fortier, G.; Laframboise, S.; May, T.; Hogen, L.F.; Covens, A.L.; et al. Assessment of Sentinel Lymph Node Biopsy vs Lymphadenectomy for Intermediate- and High-Grade Endometrial Cancer Staging. JAMA Surg. 2021, 156, 157–164.
  66. Ye, L.; Di, S.D.; Lu, W.; He, Q.Z.; Li, Y.R.; Li, B.L.; Wang, Z.J.; Yan, Q.; Wan, X.P. A Prospective Study of Sentinel Lymph Node Mapping for Endometrial Cancer: Is It Effective in High-Risk Subtypes? Oncologist 2019, 24, e1381.
  67. Torrent, A.; Amengual, J.; Sampol, C.M.; Ruiz, M.; Rioja, J.; Matheu, G.; Roca, P.; Cordoba, O. Sentinel Lymph Node Biopsy in Endometrial Cancer: Dual Injection, Dual Tracer—A Multidisciplinary Exhaustive Approach to Nodal Staging. Cancers 2022, 14, 929.
  68. Barlin, J.N.; Khoury-Collado, F.; Kim, C.H.; Leitao, M.M., Jr.; Chi, D.S.; Sonoda, Y.; Alektiar, K.; DeLair, D.F.; Barakat, R.R.; Abu-Rustum, N.R. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: Beyond removal of blue nodes. Gynecol. Oncol. 2012, 125, 531–535.
  69. Buda, A.; Di Martino, G.; Restaino, S.; De Ponti, E.; Monterossi, G.; Giuliani, D.; Ercoli, A.; Dell’Orto, F.; Dinoi, G.; Grassi, T.; et al. The impact on survival of two different staging strategies in apparent early stage endometrial cancer comparing sentinel lymph nodes mapping algorithm and selective lymphadenectomy: An Italian retrospective analysis of two reference centers. Gynecol. Oncol. 2017, 147, 528–534.
  70. Buda, A.; Gasparri, M.L.; Puppo, A.; Mereu, L.; De Ponti, E.; Di Martino, G.; Novelli, A.; Tateo, S.; Muller, M.; Landoni, F.; et al. Lymph node evaluation in high-risk early stage endometrial cancer: A multi-institutional retrospective analysis comparing the sentinel lymph node (SLN) algorithm and SLN with selective lymphadenectomy. Lymph node evaluation in high-risk early stage endometrial cancer: A multi-institutional retrospective analysis comparing the sentinel lymph node (SLN) algorithm and SLN with selective lymphadenectomy. Gynecol. Oncol. 2018, 150, 261–266.
  71. Schlappe, B.A.; Weaver, A.L.; Ducie, J.A.; Eriksson, A.G.Z.; Dowdy, S.C.; Cliby, W.A.; Glaser, G.E.; Soslow, R.A.; Alektiar, K.M.; Makker, V.; et al. Multicenter study comparing oncologic outcomes between two nodal assessment methods in patients with deeply invasive endometrioid endometrial carcinoma: A sentinel lymph node algorithm versus a comprehensive pelvic and paraaortic lymphadenectomy. Gynecol. Oncol. 2018, 151, 235–242.
  72. Salman, L.; Cusimano, M.C.; Marchocki, Z.; Ferguson, S.E. Sentinel Lymph Node Mapping in High-Grade Endometrial Cancer. Curr. Oncol. 2022, 29, 96.
  73. Takahashi, A.; Matsuura, M.; Matoda, M.; Nomura, H.; Okamoto, S.; Kanao, H.; Kondo, E.; Omatsu, K.; Kato, K.; Utsugi, K.; et al. Clinicopathological Features of Early and Late Recurrence of Endometrial Carcinoma After Surgical Resection. Int. J. Gynecol. Cancer 2017, 27, 967–972.
  74. Podratz, K.C.; Mariani, A.; Webb, M.J. Staging and therapeutic value of lymphadenectomy in endometrial cancer. Gynecol. Oncol. 1998, 70, 163–164.
  75. Chan, J.K.; Kapp, D.S. Role of complete lymphadenectomy in endometrioid uterine cancer. Lancet Oncol. 2007, 8, 831–841.
  76. Dowdy, S.C.; Borah, B.J.; Bakkum-Gamez, J.N.; Weaver, A.L.; McGree, M.E.; Haas, L.R.; Keeney, G.L.; Mariani, A.; Podratz, K.C. Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol. Oncol. 2012, 127, 5–10.
  77. Creasman, W.T. ASTEC lymphadenectomy and radiation therapy studies: Are conclusions valid? Gynecol. Oncol. 2010, 116, 293–294.
  78. Naumann, R.W. The role of lymphadenectomy in endometrial cancer: Was the ASTEC trial doomed by design and are we destined to repeat that mistake? Gynecol. Oncol. 2012, 126, 5–11.
  79. Huang, C.Y.; Tang, Y.H.; Chiang, Y.C.; Wang, K.L.; Fu, H.C.; Ke, Y.M.; Lau, H.Y.; Hsu, K.F.; Wu, C.H.; Cheng, W.F. Impact of management on the prognosis of pure uterine papillary serous cancer—A Taiwanese Gynecologic Oncology Group (TGOG) study. Gynecol. Oncol. 2014, 133, 221–228.
  80. Leath, C.A., III; Numnum, T.M.; Kendrick, J.E.; Frederick, P.J.; Rocconi, R.P.; Conner, M.G.; Straughn, J.M., Jr. Patterns of Failure for Conservatively Managed Surgical Stage I Uterine Carcinosarcoma. Implications for Adjuvant Therapy. Int. J. Gynecol. Cancer 2009, 19, 888–891.
  81. Jeppesen, M.M.; Jensen, P.T.; Hansen, D.G.; Iachina, M.; Mogensen, O. The nature of early-stage endometrial cancer recurrence—national cohort study. Eur. J. Cancer 2016, 69, 51–60.
  82. Mariani, A.; Webb, M.J.; Galli, L.; Podratz, K.C. Potential therapeutic role of para-aortic lymphadenectomy in node-positive endometrial cancer. Gynecol. Oncol. 2000, 76, 348–356.
  83. Alektiar, K.M.; Venkatraman, E.; Chi, D.S.; Barakat, R.R. Intravaginal brachytherapy alone for intermediate-risk endometrial cancer. Int. J. Radiat. Oncol. Biol. Phys. 2005, 62, 111–117.
  84. Todo, Y.; Kato, H.; Kaneuchi, M.; Watari, H.; Takeda, M.; Sakuragi, N. Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): A retrospective cohort analysis. Lancet 2010, 375, 1165–1172.
  85. Huang, C.Y.; Ho, C.M.; Chen, Y.L.; You, S.L.; Chen, C.A.; Cheng, W.F. Impact of lymphadenectomy in uterine endometrioid carcinoma. Eur. J. Surg. Oncol. 2013, 39, 350–357.
  86. Eggemann, H.; Ignatov, T.; Kaiser, K.; Burger, E.; Dan Costa, S.; Ignatov, A. Survival advantage of lymphadenectomy in endometrial cancer. J. Cancer Res. Clin. Oncol. 2016, 142, 1051–1060.
  87. Nugent, E.K.; Bishop, E.A.; Mathews, C.A.; Moxley, K.M.; Tenney, M.; Mannel, R.S.; Walker, J.L.; Moore, K.N.; Landrum, L.M.; McMeekin, D.S. Do uterine risk factors or lymph node metastasis more significantly affect recurrence in patients with endometrioid adenocarcinoma? Gynecol. Oncol. 2012, 125, 94–98.
  88. Ouldamer, L.; Bendifallah, S.; Body, G.; Canlorbe, G.; Touboul, C.; Graesslin, O.; Raimond, E.; Collinet, P.; Coutant, C.; Lavoué, V.; et al. Call for Surgical Nodal Staging in Women with ESMO/ESGO/ESTRO High-Intermediate Risk Endometrial Cancer: A Multicentre Cohort Analysis from the FRANCOGYN Study Group. Ann. Surg. Oncol. 2017, 24, 1660–1666.
  89. Morrow, C.P.; Bundy, B.N.; Kurman, R.J.; Creasman, W.T.; Heller, P.; Homesley, H.D.; Graham, J.E. Relationship between surgical-pathological risk factors and outcome in clinical stage I and II carcinoma of the endometrium: A Gynecologic Oncology Group Study. Gynecol. Oncol. 1991, 40, 55–65.
  90. Euscher, E.D.; Bassett, R.; Malpica, A. Lymph node counts in endometrial cancer: Expectations versus reality. Am. J. Surg. Pathol. 2011, 35, 913–918.
  91. Otsuka, I.; Kubota, T.; Aso, T. Lymphadenectomy and adjuvant therapy in endometrial carcinoma: Role of adjuvant chemotherapy. Br. J. Cancer 2002, 87, 377–380.
  92. Fanning, J.; Nanavati, P.J.; Hilgers, R. Surgical staging and high dose rate brachytherapy for endometrial cancer: Limiting external radiotherapy to node-positive tumors. Obstet. Gynecol. 1996, 87, 1041–1044.
  93. Abu-Rustum, N.R.; Iasonos, A.; Zhou, Q.; Oke, E.; Soslow, R.A.; Alektiar, K.M.; Chi, D.S.; Barakat, R.R. Is there a therapeutic impact to regional lymphadenectomy in the surgical treatment of endometrial carcinoma? Am. J. Obstet. Gynecol. 2008, 198, 457.e1–457.e6.
  94. Huang, M.; Chadha, M.; Musa, F.; Friedmann, P.; Kolev, V.; Holcomb, K. Lymph nodes: Is total number or station number a better predictor of lymph node metastasis in endometrial cancer? Gynecol. Oncol. 2010, 119, 295–298.
  95. Kilgore, L.C.; Partridge, E.E.; Alvarez, R.D.; Austin, J.M.; Shingleton, H.M.; Noojin, F.; Conner, W. Adenocarcinoma of the endometrium: Survival comparison of patients with and without pelvic node sampling. Gynecol. Oncol. 1995, 56, 29–33.
  96. Sosa, J.A.; Diener-West, M.; Gusev, Y.; Choti, M.A.; Lange, J.R.; Dooley, W.C.; Zeiger, M.A. Association between extent of axillary lymph node dissection and survival in patients with stage I breast cancer. Ann. Surg. Oncol. 1998, 5, 140–149.
  97. Weir, L.; Speers, C.; D’Yachkova, Y.; Olivotto, I.A. Prognostic significance of the number of axillary lymph nodes removed in patients with node-negative breast cancer. J. Clin. Oncol. 2002, 20, 1793–1799.
  98. Gajra, A.; Newman, N.; Gamble, G.P.; Kohman, L.J.; Graziano, S.L. Effect of number of lymph nodes sampled on outcome in patients with stage I non-small-cell lung cancer. J. Clin. Oncol. 2003, 21, 1029–1034.
  99. Shah, M.; Lewin, S.N.; Deutsch, I.; Burke, W.M.; Sun, X.; Herzog, T.J.; Wright, J.D. Therapeutic role of lymphadenectomy for cervical cancer. Cancer 2011, 117, 310–317.
  100. Chen, S.S. Operative treatment in stage I endometrial carcinoma with deep myometrial invasion and/or grade 3 tumor surgically limited to the corpus uteri. No recurrence with only primary surgery. Cancer 1989, 63, 1843–1845.
  101. Ayhan, A.; Taskiran, C.; Celik, C.; Guney, I.; Yuce, K.; Ozyar, E.; Atahan, L.; Kucukali, T. Is there a survival benefit to adjuvant radiotherapy in high-risk surgical stage I endometrial cancer? Gynecol. Oncol. 2002, 86, 259–263.
  102. Straughn, J.M.; Huh, W.K.; Orr, J.W.; Kelly, F.J.; Roland, P.Y.; Gold, M.A.; Powell, M.; Mutch, D.G.; Partridge, E.E.; Kilgore, L.C.; et al. Stage IC adenocarcinoma of the endometrium: Survival comparisons of surgically staged patients with and without adjuvant radiotherapy. Gynecol. Oncol. 2003, 89, 295–300.
  103. Orr, J.W., Jr.; Holimon, J.L.; Orr, P.F. Stage I corpus cancer: Is teletherapy necessary? Am. J. Obstet. Gynecol. 1997, 176, 777–789.
  104. Berclaz, G.; Hänggi, W.; Kratzer-Berger, A.; Altermatt, H.J.; Greiner, R.H.; Dreher, E. Lymphadenectomy in high risk endometrial carcinoma stage I and II: No more morbidity and no need for external pelvic radiation. Int. J. Gynecol. Cancer 1999, 9, 322–328.
  105. Horowitz, N.S.; Peters, W.A., III; Smith, M.R.; Drescher, C.W.; Artwood, M.; Mate, T.P. Adjuvant high dose rate vaginal brachytherapy as treatment of stage I and II endometrial carcinoma. Obstet. Gynecol. 2002, 99, 235–240.
  106. Mariani, A.; Webb, M.J.; Keeney, G.L.; Calori, G.; Podratz, K.C. Hematogenous dissemination in corpus cancer. Gynecol. Oncol. 2001, 80, 233–238.
  107. Otsuka, I.; Ono, I.; Akamatsu, H.; Sunamori, K.; Aso, T. Pulmonary metastasis from endometrial carcinoma. Int. J. Gynecol. Cancer 2002, 12, 208–213.
  108. Matsuo, K.; Yabuno, A.; Hom, M.S.; Shida, M.; Kakuda, M.; Adachi, S.; Mandelbaum, R.S.; Ueda, Y.; Hasegawa, K.; Enomoto, T.; et al. Significance of abnormal peritoneal cytology on survival of women with stage I–II endometrioid endometrial cancer. Gynecol. Oncol. 2018, 149, 301–309.
  109. Brown, A.P.; Gaffney, D.K.; Dodson, M.K.; Soisson, A.P.; Belnap, T.W.; Alleman, K.; Sause, W.T. Survival analysis of endometrial cancer patients with positive lymph nodes. Int. J. Gynecol. Cancer 2013, 23, 861–868.
  110. Otsuka, I.; Kadooka, M.; Matsuura, T. Long-term survival of a patient with stage IIIC2 grade 3 endometrioid endometrial carcinoma treated with surgery alone. Gynecol. Oncol. Rep. 2021, 38, 100869.
  111. Goebel, E.A.; St Laurent, J.D.; Nucci, M.R.; Feltmate, C.M. Retrospective detection of isolated tumor cells by immunohistochemistry in sentinel lymph node biopsy performed for endometrial carcinoma: Is there clinical significance? Int. J. Gynecol. Cancer 2020, 30, 291–298.
  112. Backes, F.J.; Felixb, A.S.; Plante, M.; Grégoire, J.; Sullivan, S.A.; Rossi, E.C.; Tanner, E.J., III; Stewart, K.I.; Soliman, P.T.; Holloway, R.W.; et al. Sentinel lymph node (SLN) isolated tumor cells (ITCs) in otherwise stage I/II endometrioid endometrial cancer: To treat or not to treat? Gynecol. Oncol. 2021, 161, 347–352.
  113. Ghoniem, K.; Larisha, A.M.; Dinoi, G.; Zhou, X.C.; Alhilli, M.; Wallace, S.; Wohlmuth, C.; Baiocchi, G.; Tokgozoglu, N.; Raspagliesi, F.; et al. Oncologic outcomes of endometrial cancer in patients with low-volume metastasis in the sentinel lymph nodes: An international multi-institutional study. Gynecol. Oncol. 2021, 162, 590–598.
  114. Plante, M.; Stanleigh, J.; Renaud, M.-C.; Sebastianelli, A.; Grondin, K.; Gregoire, J. Isolated tumor cells identified by sentinel lymph node mapping in endometrial cancer: Does adjuvant treatment matter? Gynecol. Oncol. 2017, 146, 240–246.
  115. Ignatov, A.; Ivros, S.; Bozukova, T.; Papathemelis, T.; Ortmann, O.; Eggemann, H. Systematic lymphadenectomy in early stage endometrial cancer. Arch. Gynecol. Obstet. 2020, 302, 231–239.
  116. Papathemelis, T.; Hassas, D.; Gerken, M.; Klinkhammer-Schalke, M.; Scharl, A.; Lux, M.P.; Beckmann, M.W.; Scharl, S. Is there a benefit of lymphadenectomy for overall and recurrence-free survival in type I FIGO IB G1-2 endometrial carcinoma? A retrospective population-based cohort analysis. J. Cancer Res. Clin. Oncol. 2018, 144, 2019–2027.
  117. Gayar, O.H.; Robbins, J.R.; Parikh, K.; Lu, M.; Buekers, T.; Munkarah, A.; Elshaikh, M.A. Hysterectomy for uterine adenocarcinoma in the elderly: Tumor characteristics, and long-term outcome. Gynecol. Oncol. 2011, 123, 71–75.
  118. Hachisuga, K.; Ohishi, Y.; Tomonobe, H.; Yahata, H.; Kato, K.; Oda, Y. Endometrial endometrioid carcinoma, G1, is more aggressive in the elderly than in the young. Histopathology 2021, 79, 708–719.
  119. Pawelec, G. Does patient age influence anti-cancer immunity? Semin. Immunopathol. 2019, 41, 125–131.
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