The problem of lymphadenectomy: Contra

Endometrial cancer treatment includes peritoneal cytology, total hysterectomy, bilateral salpingo-oophorectomy. However, there is no general consensus on the surgical approach to endometrial cancer and therefore surgical practice varies widely around the world. Lymph node status still remains difficult to be assessed pre-operatively and intra-operatively with the highest level of accuracy. Currently, the role of lymphadenectomy is completely recognized with a staging aim, but its possible therapeutic role remains a particularly debated issue. For this reason, performing lymphadenectomy in all women affected by endometrial cancer seems to burden complications rate, without a substantial survival benefit. Clinical evidence takes us to recommend lymphadenectomy in high risk patients only when the real risk of nodal spread justifies the morbidity of the procedure (particular histotypes, suspected advanced disease), but its therapeutic role has not been demonstrated. In the future the oncologic community may develop the use of accurate molecular markers to preoperatively select patients to undergo complete lymphadenectomy. However, to better define all the unsolved questions, high quality scientific evidence in endometrial cancer clinico-surgical management is mandatory. © 2013 by Nova Science Publishers, Inc. All rights reserved.