Retroperitoneal lymph node surgical evaluation for endometrial cancer: Survey of practice among Thai gynecologic oncologists

Abstract

© Journal of The Medical Association of Thailand Objective: To evaluate the current practice of lymph node evaluation during surgery in endometrial cancer patients. Materials and Methods: This report was a part of the survey study by the Thai Gynecologic Cancer Society which assessed the practice of Thai gynecologic oncologists who had been in practice for at least one year. The web-based survey was conducted from August to October, 2019. Data on the practice of node resection (all vs. selective), pattern (systemic vs. sampling) and level of lymph node resection (pelvic only vs. pelvic and para-aortic nodes) as well as the number of retrieved lymph nodes in endometrial cancer patients were extracted from the database. Results: From 170 gynecologic oncologists, who responded to the questionnaire, the duration of practice ranged from 1 to 42 years (median 5 years). Almost 90% and 84% worked in government hospitals or tertiary-level hospitals respectively, with 50.6% involved in gynecologic fellows training. All performed lymph node resection. The procedure was either when there were indications (57.1%), or generally performed in all patients (42.9%) which was more frequently practiced among the respondents who had been working for >5 years. The four most common features considered for nodal resection were tumor size, histopathology, grade, and myometrial invasion. Regarding the pattern of resection, 67.6% performed systemic dissection, all did it bilaterally, and 85.3% resected both pelvic and para-aortic nodes. No significant influences of the hospital's features or the respondents' experience on the pattern or level of lymph node surgery. Median numbers of pelvic and para-aortic nodes yielded per patient were 12 nodes (3 to 30 nodes) and 3 nodes (0 to 20 nodes), respectively. The respondents working in the government or training hospitals were more likely to have pelvic node retrieval >12 nodes whereas only the respondents who worked in training hospitals had >3 retrieved paraaortic nodes more frequently. Conclusion: Variations in the practice of surgical lymph node evaluation in endometrial cancer patients were demonstrated among the Thai gynecologic oncologists. The differences lied on experience and the context of the working features of an individual.