[Modern tendencies in the surgical treatment of the early detected endometrial cancers--with or without lymph node dissection].

AIM: Our aim was to evaluate retrospectively for 10 years period, the patients operated for endometrial cancer with or without lymph node dissection. MATERIAL AND METHODS: The patients who entered the research work were mainly from the National Oncological Centre-Sofia, Obstetrics and Gynecological Hospital-Varna and some experience, data and advice from the RHW-Sydney. We evaluated two groups of patients. The first group of 450 patients operated with total abdominal hysterectomy (type II), BSO without lymph node dissection and second group of 450 patients-with radical abdominal hysterectomy, BSO with pelvic and/or paraaortal lymph node dissection. RESULTS: The results in both groups were evaluated. The median survival follow up was from 3 to 5 years. The patients with pelvic or paraaortal lymph node dissection have statistically significant better overall survival (p-0.0003) and also better survival for the patients with low risk as well as for patients with high risk (for low risk patients--p=0.028; for patients with high risk--p=0.0008). DISCUSSION: Our approach differs a little bit from the surgical practice in some clinics with super radicality, where paraaortic lymphadenectomy is more commonly advocated. We do not offer routine paraaortal lymphadenectomy, because of the fact that the presence of paraaortal metastases is very little, when there is a lack of pelvic metastases. According to our data the resection of the bulky paraaortal lymph nodes is enough. The patients with high risk for paraaortal metastases are as follows: patients with bulky positive pelvic lymph nodes; patients with positive enlarged adnexa; patients with grade 2 and 3 and invasion in the outer third of the myometrium. CONCLUSIONS: According to our results and assessing the 3 and 5 years survival rate, the second group of patients (450 patients) in whom pelvic and paraaortal lymph node dissection is performed had statistically better survival rate, as well as better survival for the low risky group and high risky group.