[1115] Number of Lymph Nodes in Staging for Endometrialo Cancer: Is the Minimum Required by Some GOG Protocols Feasible?

Chiraag Patel, Dimple Pandya, Michael Pearl, Carmen Tornos. Stony Brook University Medical Center, NY

Background: GOG protocol 0210 is a molecular and surgico-pathological staging study of endometrial carcinoma. A requirement to enroll patients in this protocol is the presence of at least 8 pelvic lymph nodes (4 right, and 4 left), and 4 para-aortic nodes (2 right and 2 left). The aim of our study was to see the feasibility of obtaining these minimum number of lymph nodes in patients with endometrial carcinoma (many of whom are obese), and the impact that the surgeon may have in the number of nodes obtained.
Design: We retrospectively reviewed the pathology report of 146 consecutive patients with endometrial carcinoma surgically staged at our Institution from 1/1/2000 to 12/31/2005. The surgeons were six board certified gynecological oncologists with multiple years of experience. The patients underwent abdominal hysterectomy, bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy. None of the cases were done laparoscopically.
Results: The diagnoses included: 100 type 1 endometrial carcinomas (endometrioid), and 46 type 2 endometrial carcinomas (serous, clear cell, undifferentiated, or mixed). The total number of pelvic nodes per patient ranged from 0 to 43 (mean 14.13), including a mean of 7.33 in the right and a mean of 6.80 in the left. The total number of para-aortic nodes ranged from 0 to 33 (mean 5.10). The table shows the mean number of nodes found per surgeon and location.

Surgeon	Mean Rt pelvic	Mean Lt pelvic	Mean para-aortic	Total # cases
A	8.43	7.71	8.50	42
B	7.70	7.40	4.60	10
C	4.92	4.85	2.85	13
D	8.96	6.65	5.27	26
E	6.33	6.59	3.04	51
F	4.75	5.75	3.00	4
Total Average	7.33	6.80	5.10

There were no cases which did not identify any pelvic lymph nodes (left or right), and only one case where no para-aortic nodes were identified. 78 cases (53.42%) had less than the minimum number of pelvic and para-aortic lymph nodes required in the GOG 0210. Of the 78 cases, 54 were type 1 endometrial carcinoma, and 24 were type 2 endometrial carcinoma.
Conclusions: The minimum number of lymph nodes required by the GOG to accept patients into Protocol 0210 is often difficult to attain. In our study the majority of cases that failed to reach the minimum number were obese patients with type 1 endometrial carcinoma, in which dissection of para-aortic lymph nodes may have been technically challenging.
Category: Gynecologic & Obstetrics

Monday, February 28, 2011 2:30 PM

Platform Session: Section C, Monday Afternoon