This study determines the role of pelvic lymphadenectomy by assessing nodal positivity on progression free and overall survival in early stage endometrial cancer.
89 women diagnosed with stage I /Stage II endometrial cancer at presentation who underwent pelvic lymphadenectomy were included in this study. In addition to patient characteristics, final histopathology including cytology, type of surgery (laparoscopic vs open), radiological evidence of lymphadenopathy before surgery, number of lymph nodes retrieved, histopathological evidence of nodal positive/ negative disease, adjuvant therapy (if any), recurrence free survival and overall survival were noted for these patients. 
The rate of laparoscopic surgery was 65.2% in this study cohort with radiological evidence of lymphadenopathy in 17 patients. Only 6 patients were found to have nodal positive disease out of which only 3 had lymphadenopathy on scans. 51.7% patients received adjuvant radiation therapy whilst 18% underwent adjuvant chemotherapy. The estimated mean survival was 65.6 months, with recurrence free survival being 61.7 months. Amongst the patients with lymph node positive disease only one was found to have disease recurrence despite adjuvant treatment. 

This study elucidates that patients who underwent pelvic lymphadenectomy and were subsequently found to have nodal disease went on to receive adequate adjuvant therapy, however for some of them there was no specific pre-operative indicator to prompt the decision for pelvic lymphadenectomy. Therefore until advanced techniques such as sentinel lymph node mapping is available in low resource countries, surgical staging with pelvic nodal sampling is recommended.

Dr Kheyal Azam Khalil is a fellow in Gynecological Oncology at one of the biggest cancer centers of Pakistan. She completed her Obstetrics and Gynecology residency training in Pakistan and the UK. She has special interest in Gynecological Cancers and minimally invasive surgery.