Background: Endometrial cancer is the fifth most common cancer among women worldwide. Systematic lymphadenectomy of pelvic lymph nodes (LN) and para-aortic are often part of surgical staging. This procedure is not done universally. The therapeutic effects of lymphadenectomy are issues of great debate.Complications of lymphadenectomy including lymphadenoma and lymphatic cysts can affect patients' quality of life.
Objective: To evaluate the use of systematic pelvic lymphadenectomy in the management of endometrial cancer.
Patients and Methods:  A descriptive retrospective cohort study was conducted in multi-centric three national cancer institutes (Tripoli, Misurata, and Sabratha) located at Western -Northern Libya, from January 2020 toMay2022. A total number of 180 diagnosedendometrial cancer cases were enrolled in the study.In all cases routine systematic pelvic lymphadenectomy was conducted. Theprimary outcome measure was the rate of lymph node metastases in relation to tumor (size, depth of endometrial invasion, grade, histopathological findings, and lymph-vascular space invasion) and patients' characteristics (age, parity, co-morbidities including obesity).
Results: There was no significant association between lymph nodemetastasis and patients' characteristics.Patients were divided into two groups: below sixty years old and above sixty,menstrual status into perimenopausal, and postmenstrual,parity, nullipara, and multipara, obesity body mass index (BMI) below 25 and above 25, and presence or absence of comorbidities.
There were significant associations with all tumor factors except tumor size.Stage Irepresented nearly 60% of sample (59.44%), stage II 18.9%, stage III 18.3%, and stage IV (3.3%). Low risk patients (FIGO stage I, grade 1-2) had 6.52% lymph node, intermediaterisk (FIGO stage II, any grade) had 17.65% lymph node invasion, and high risk (FIGOIII, and FIGO IV 84.8%, and 100% respectively. (The overall incidence of lymph node metastasis in clinically uterine-confined endometrial cancer was proportionally increasing with the increase in gradings. (About9% in grade 1, 19% in grade 2, and 76% in grade 3).Lymph node metastasis occurred in 11% of cases with less than 50% myometrial invasion,compared with about 38% of patients with more than 50% myometrial invasion.Histopathologicallymore invasion occurred with poorly differentiatedtumors(64%), and the least occurred with endometrioid carcinoma (23%). Lymph-vascular space invasion significantly affected lymph node metastasis, it occurred in 15.2% of low risk group (FIGO stage I) was highest (100%) in high risk group (FIGO stage IV).
Conclusion:Use of more precise and less aggressive methods may be useful to predict tumor aggressiveness and lymph node metastasis. Such methods include preoperatively theuse ofmolecular markers, computerized tomogram scan(CT), magnetic resonance images (MRI), ultrasound scanning, and the intra-operatively use of sentinel lymph nodes mapping during surgical procedures. These investigations should be considered to assess ovarian, nodal, peritoneal, and other sites of metastatic disease.