Akademik Veri Yönetim Sistemi
BMC SURGERY, cilt.26, sa.1, 2026 (SCI-Expanded, Scopus)
Objective The therapeutic role of lymphadenectomy in endometrial cancer remains controversial. Although systematic pelvic and para-aortic lymphadenectomy (PPLND) has been suggested to improve survival in certain patients, randomized trials have failed to demonstrate a definitive benefit. This study aimed to evaluate the therapeutic value of lymphadenectomy according to risk groups in patients with early-stage, node-negative endometrioid endometrial cancer. Methods A retrospective review was conducted of 654 lymph node-negative patients with FIGO 2009 stage I-II endometrioid endometrial carcinoma who underwent primary surgical treatment at Bursa Uluda & gbreve; University between 2000 and 2025. Patients were categorized into three surgical groups: no lymphadenectomy (n = 139), pelvic lymphadenectomy (PLND, n = 119), and combined pelvic plus para-aortic lymphadenectomy (PPLND, n = 396). Clinicopathological features, recurrence patterns, disease-free survival (DFS), and overall survival (OS) were compared across groups. Subgroup analyses were performed for low-, intermediate-, and high-intermediate-risk categories. Results Adverse pathological features including stage IB-II disease, higher grade, deep myometrial invasion, and LVSI were more frequent in the PPLND group (all p < 0.001). Recurrence rates were 9.4% (13/139) in the no-lymphadenectomy group, 5.9% (7/119) after PLND, and 8.3% (33/396) after PPLND, with no significant difference between groups (p = 0.575). However, local recurrences predominated in the no-lymphadenectomy group, whereas distant relapses were more common after PPLND (p = 0.016). In univariate analysis, FIGO stage, LVSI, deep myometrial invasion, and adjuvant chemoradiotherapy were associated with poorer DFS; in multivariate analysis, only chemoradiotherapy remained an independent adverse factor (HR 2.30, 95% CI 1.04-5.10, p = 0.041). For OS, age was the sole independent prognostic factor (HR 1.09, 95% CI 1.07-1.11, p < 0.001). Kaplan-Meier analysis by risk group showed no significant survival differences: in the low-risk group, PPLND patients displayed more favorable DFS/OS curves without statistical significance (DFS p = 0.340; OS p = 0.278). No survival benefit was observed in intermediate (DFS p = 0.725; OS p = 0.935) or high-intermediate-risk groups (DFS p = 0.449; OS p = 0.543). Conclusions Systematic lymphadenectomy does not provide a therapeutic survival benefit in early-stage, node-negative endometrioid endometrial cancer, irrespective of risk stratification. The principal value of nodal assessment lies in accurate staging and guiding adjuvant therapy.