Successful salvage treatment of recurrent endometrial cancer with bulky central tumor and extensive lymph node metastasis. A case report

Recurrent endometrial cancer with both local and distant metastasis is very difficult to treat. A 55-year-old endometrial adenocarcinoma patient with bulky central recurrences and pelvic and inguinal lymph node metastases underwent laparotomy and paraaortic, pelvic and inguinal lymphadenectomy followed by concurrent chemoradiation (with cisplatin) to the paraaortic and inguinal lymph nodes as well as the whole pelvis. Neck and mediastinal lymph node metastasis emerged during treatment. Neck-node radiation and epirubicin was added followed by paclitaxel and carboplatin. Complete remission was achieved. Ten months later, isolated central re-recurrence happened and total pelvic exenteration was performed. The patient has survived without further recurrence for more than five years after the exenteration. Therefore, a multimodality approach with a combination of radical resection (even pelvic exenteration), radiotherapy and chemotherapy could be offered to well-selected patients with recurrent endometrial cancer despite out-of-field progression during therapy and in-field local failure to initial salvage treatment.     

Endometrioid carcinoma of the ovary presenting with an enlarged inguinal lymph node without evidence of abdominal carcinomatosis.

It is generally recognized that ovarian cancer tends to remain intraabdominal even in advanced cases and that dissemination is usually by invasion of adjacent viscera, diffuse intraperitoneal implantation, and metastatic involvement of aortic and pelvic lymph nodes. Primary ovarian lymphatic drainage occurs via the infundibulopelvic ligament to the paraaortic nodes. The presence of an ovarian tumor extending into adjacent pelvic viscera may allow direct lymphatic continuity with inguinal, external, and common iliac lymph nodes. In the absence of such extension it is traditionally believed that the drainage via the infundibulopelvics is so important that only with its blockage, presumably by tumor emboli, can retrograde drainage to pelvic and inguinal nodes occur. We report a case of a patient presenting with a large metastatic inguinal lymph node from a primary epithelial ovarian cancer without evidence of disseminated intraabdominal disease or gross evidence of pelvic or paraaortic lymph node involvement.     

Risk of lymph node metastases in patients with ovarian cancer

AIM: The aim of this study was the assessment of incidence of the lymph node spread in patients with ovarian cancer. Additionally, some of clinical and histopathology factors, as well as patients age were analyzed in relation with lymph nodes metastases. MATERIAL AND METHOD: Based on 112 operations performed in patients with ovarian cancer FIGO stage I-IV, analysis of pelvic and paraaortic lymph node metastasis was carried out. In this group only in 70 patients paraaortic lymph nodes were removed. The rest of patients underwent pelvic lymphadenectomy only because of poor general condition or very intensive cytoreductive surgery. Statistical analysis was provided using unvaried regression test and Pearson test. RESULTS: In early stages of ovarian cancer (I and II) the percent of patients with involved lymph nodes was 17.4 and in advanced stages 37.9. Strong correlation between involvement of pelvic and paraaortic lymph nodes was seen. The most frequent localization of lymph node metastases was the site around intercrossing of left renal vein and aorta. It should be stressed that in 8 cases isolated paraaortic metastases were seen. Risk factors of lymph node metastases were clinical stage, tumor grade and age of patients. Clear cell carcinoma and mixed carcinoma had also prognostic significance. CONCLUSION: This analysis proved that incidence of lymph node metastases was high even in early stage, and therefore lymphadenectomy should be an integral part of standard surgical procedures in patients with ovarian cancer.     

Two paraneoplastic syndromes in a patient with ovarian cancer: nephrotic syndrome and paraneoplastic cerebellar degeneration

BACKGROUND: A paraneoplastic syndrome-a rare, indirect system disturbance located distant from a neoplasm-has been reported in association with ovarian cancer. CASE: Two paraneoplastic syndromes-nephrotic syndrome and paraneoplastic cerebellar degeneration (PCD)-developed in a patient who had no symptoms from ovarian cancer. She presented with the nephrotic syndrome. Evaluation for metastasis, including computed tomography (CT) scan and ultrasonography, showed a slightly enlarged right ovary and a 2-cm lower paraaortic lymph node on the right side. A 5-cm ovarian mass and multiple paraaortic lymph nodes were excised, and six cycles of carboplatin and paclitaxel were given. Nephrotic syndrome symptoms had greatly subsided at 6 weeks after surgery. At 7 months after surgery, symptoms of PCD developed yet CT, CA-125 levels, and physical examination showed no evidence of ovarian cancer. CONCLUSION: To our knowledge, development of two paraneoplastic syndromes in one patient with ovarian cancer has not been reported. Nephrotic syndrome resolved with treatment of the neoplasm whereas PCD did not.     

Surgical staging of cervical cancer

Noninvasive radiologic methods to detect paraaortic lymph node metastases are reliable when combined with FNA of enlarged lymph nodes. However, the sensitivity is low, and undetected microscopic metastases leads to treatment failure. These patients with paraaortic lymph node metastasis are not treated with extended-field radiation, and they all die within 3 years. The CT scanning is probably the best diagnostic method to evaluate cervical cancer, because it can assess the primary tumor, the urinary tract, gastrointestinal tract, liver parenchyma, and retroperitoneum. It also permits the guidance of FNA and the arrangement of radiation ports. Surgical staging provides the direct assessment of the peritoneal cavity and the retroperitoneal spaces. Metastatic tumor, including enlarged lymph nodes, can be resected, but this is of dubious benefit. The operative morbidity is acceptable, with fewer intestinal complications when the extraperitoneal approach is used, and long-term morbidity is minimal when appropriate paraaortic radiation doses are employed (less than 5,000 cGy). Surgical staging has provided data on the frequency of paraaortic lymph node metastasis by stage of cervical cancer, and thus, treatment strategies can be better developed. Extended-field radiation results in 5-year survival rates of 20-25% in patients with microscopic paraaortic lymph node metastasis, patients who would not survive without the treatment. However, surgical staging has produced only a modest boost in survival rates, because of the high rate of pelvic and systemic failure. When extended-field radiation is used prophylactically or in patients with probable lymph node metastasis seen on radiographic studies, survival rates are similar to patients irradiated after surgical staging finds paraaortic lymph node disease. As our ability to predict, and detect nonsurgically, positive paraaortic node disease improves, extended radiation (or other adjuvant therapy) could be used more frequently without operation in patients who are at high risk for metastatic disease. In a study by Haie et al, prophylactic paraaortic radiation was given to patients at high risk for paraaortic metastasis. In patients with a high probability of local disease control, paraaortic radiation significantly reduced the incidence of paraaortic and distant metastases. Patients with known paraaortic lymph node metastases frequently have occult systemic metastases. In these same patients, pelvic failure is also common. Thus, until effective systemic therapies emerge, a marked improvement in survival is unlikely in patients who have paraaortic lymph node metastasis.(ABSTRACT TRUNCATED AT 400 WORDS)     

Lymphatic mapping and sentinel node identification as related to the primary sites of lymph node metastasis in early stage ovarian cancer

OBJECTIVE: We evaluated the primary sites of lymph node (LN) metastasis in patients during the early stage of ovarian cancer. METHODS: Study 1: patients with clinical stage I and II common epithelial ovarian carcinoma (n = 150) underwent systematic retroperitoneal LN dissection of the pelvic and paraaortic areas. The relationship between the incidence and location of LN metastasis and clinical and histological characteristics was examined. Study 2: we studied 11 women with endometrial or fallopian tube tumors. At laparotomy, activated charcoal solution was injected into the unilateral cortex of the ovary. Ten minutes later, the retroperitoneal spaces were opened and charcoal uptake within the pelvic lymph node (PLN) and paraaortic node (PAN) as far as the level of renal vein was examined. RESULTS: Study 1: The incidence of LN metastasis by stage was 6.5% (8/123) in stage I and 40.7% (11/27) in stage II. Among 19 patients with LN metastasis, 14 had only PAN, 2 had only pelvic LN, and 3 had both PAN and PLN metastases. Metastasis was limited to the ipsilateral side in 12 (63%) patients, but was bilateral in 5 (26%) and contralateral to the neoplastic ovary in 2 (11%). Positive peritoneal cytology was significantly (P < 0.05) correlated with lymph node metastasis. Study 2: Lymphatic channels along the ovarian vessels were identified in all injected ovaries. Charcoal was deposited in the LN of all patients. The locations of these nodes included PAN in all patients, common iliac node in three, and external iliac node in one. CONCLUSION: PAN is the primary site of LN metastasis in ovarian cancer. Bilateral PAN dissections are necessary to determine the extent of tumors even in stage I ovarian carcinoma.     

Lymphovascular space involvement is the sole independent predictor of lymph node metastasis in clinical early stage endometrial cancer

Purpose

To determine clinicopathological risk factors associated with lymph node metastasis in endometrial cancer (EC).

Methods

Clinicopathological data of patients who underwent comprehensive surgical staging for clinical early stage EC between 2001 and 2010 at Hacettepe University Hospital was retrospectively reviewed.

Results

Two hundred and sixty-one patients were included. There were 26 patients (10.0 %) with lymph node metastasis. Of these, 14 (5.4 %) had pelvic lymph node metastasis, 8 (3.1 %) had both pelvic and paraaortic lymph node metastasis, and 4 (1.5 %) had isolated paraaortic metastasis. Univariate analysis revealed tumor size >2 cm, type II cancer, grade III histology, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, and presence of lymphovascular space involvement (LVSI) as significant clinicopathological factors associated with retroperitoneal lymph node metastasis. For paraaortic metastasis either isolated or with pelvic lymph node metastasis, significant factors were grade III disease, cervical stromal invasion, deep myometrial invasion, positive peritoneal cytology, adnexal involvement, serosal involvement, pelvic lymph node metastasis, and presence of LVSI. The only factor associated with isolated paraaortic lymph node metastasis was LVSI. Multivariate analysis revealed LVSI as the only independent factor for both retroperitoneal and paraaortic lymph node metastasis (odds ratio 14.9; 95 % confidence interval 3.8–59.0; p < 0.001, and odds ratio 20.9; 95 % confidence interval 1.9–69.9; p = 0.013, respectively).

Conclusion

Lymphovascular space involvement is the sole predictor of lymph node metastasis in EC. Therefore, LVSI status should be requested from the pathologist during frozen examination whenever possible to consider when a decision to perform or omit lymphadenectomy is made.     

An unusual case of recurrent endometrial cancer presented with isolated cervical lymph node metastasis

Endometrial cancer (EC) is the most common malignancy of the female genital tract. Lymph node involvement is one of the major prognostic factors. Therefore, pelvic and paraaortic lymph nodes dissection is a part of the surgical management of these patients. Isolated peripheral lymph node metastasis has not been previously reported as a finding of recurrence in EC. We report a 67-year-old woman with recurrent EC presented with an isolated cervical lymph node metastasis (ICLM). Following the combination chemotherapy of doxorubicin, cisplatin and cyclophosphamide, her cervical lymph node was completely regressed. To our knowledge, this is the first case of recurrent EC presented with ICLM. We suggest that for women with EC who had isolated peripheral lymphadenopathies, peripheral lymph node metastasis should be considered as the finding of recurrence in patient with EC.     

Pretherapeutic scalene lymph node biopsy in ovarian cancer

To study scalene lymph node involvement in ovarian cancer, 37 patients with this disease underwent pretherapeutic open sampling of the left scalene fat tissue. Only 1 patient had a palpable supraclavicular mass. Positive scalene nodes were found in 7 (22%) of 32 patients with stage III or IV disease. Three of four patients with positive scalene nodes also had both positive pelvic and positive paraaortic nodes; one patient with stage IV disease had negative pelvic and paraaortic nodes. Demonstration of scalene node involvement per se currently does not alter the management of patients with ovarian cancer, although patients with occult involvement of the scalene nodes could be considered ineligible for intraperitoneal chemotherapy.     

Preoperative CT study of lymph nodes in cervical cancer--its correlation with histological findings

A study was conducted to retrospectively evaluate the accuracy of abdominopelvic computed tomography (CT) in the diagnosis of paraaortic and pelvic lymph node metastases from carcinoma of the uterine cervix. Seventy patients with a diagnosis of invasive carcinoma of the cervix had preoperative CT of abdomen and pelvis and subsequently underwent a radical hysterectomy with pelvic lymph node dissection and paraaortic lymph node biopsy or an exploratory laparotomy with paraaortic lymph node biopsy. Five of six patients with metastatic paraaortic lymph nodes larger than 15 mm in diameter on the histologic slides were diagnosed by CT scan to have enlarged nodes. CT diagnosis was true-positive in five of seven patients with paraaortic lymph node metastases (71.4%). Two patients with false-positive paraaortic lymph nodes had clusters of small lymph nodes less than 10 mm in diameter on the histologic slides. In contrast, only a small number of the metastatic pelvic nodes were diagnosed by CT as enlarged nodes. CT diagnosis was true-positive in 5 of 11 sites with pelvic lymph node metastases (45.5%).     

Lymph node metastasis in stage I epithelial ovarian cancer

OBJECTIVES: A relatively high incidence of para-aortic and pelvic lymph node metastasis is found in epithelial ovarian cancer. This paper investigates the clinicomorphological features of intra-abdominal stage I epithelial ovarian cancer that may predict the occurrence of lymph node metastasis and the prognosis of patients in whom lymph node metastases are identified. METHODS: From November 1988 to December 1997 we performed systematic para-aortic and pelvic lymphadenectomy as primary surgery in 47 patients with intra-abdominal stage I epithelial ovarian cancer. The incidence of lymph node metastasis in these patients and the clinicomorphological features of the patients with lymph node involvement were examined. RESULTS: Five patients (10.6%) were metastasis positive (IC: four; IA: one), of whom four had serous adenocarcinoma. Serous adenocarcinoma was associated with a significantly higher incidence of metastases than other histological types (P < 0.05). The number of positive lymph nodes was one in four patients and two in one patient, and the metastatic sites ranged from the para-aortic to the suprainguinal lymph nodes. All five metastasis-positive patients were alive and disease free at the time of this report (survival 28-85 months: median 59 months). CONCLUSION: This clinical study suggests that serous adenocarcinoma carries a high risk of lymph node metastasis, requiring systematic lymphadenectomy for accurate staging in intra-abdominal stage I epithelial ovarian cancer.     

Pelvic Lymphadenectomy in Vulvar Cancer – Does it make sense?

Since the publication of the updated German guideline in 2015, the recommendations for performing pelvic lymphadenectomy (LAE) in patients with vulvar cancer (VSCC) have changed considerably. The guideline recommends surgical lymph node staging in all patients with a higher risk of pelvic lymph node involvement. However, the current data do not allow the population at risk to be clearly defined, therefore, the indication for pelvic lymphadenectomy is still not clear. There are currently two published German patient populations who had pelvic LAE which can be used to investigate both the prognostic effect of histologically verified pelvic lymph node metastasis and the relation between inguinal and pelvic lymph node involvement. A total of 1618 patients with primary FIGO stage ≥ IB VSCC were included in the multicenter AGO CaRE-1 study (1998 – 2008), 70 of whom underwent pelvic LAE. During a retrospective single-center evaluation carried out at the University Medical Center Hamburg-Eppendorf (UKE), a total of 514 patients with primary VSCC treated between 1996 – 2018 were evaluated, 21 of whom underwent pelvic LAE. In both cohorts, around 80% of the patients who underwent pelvic LAE were inguinally node-positive, with a median number of three affected groin lymph nodes. There were no cases of pelvic lymph node metastasis without inguinal lymph node metastasis in either of the two cohorts. Between 33 – 35% of the inguinal node-positive patients also had pelvic lymph node metastasis; the median number of affected groin lymph nodes in these patients was high (> 4), and the maximum median diameter of the largest inguinal metastasis was > 40 mm in both cohorts. Pelvic lymph node staging and pelvic radiotherapy is therefore probably not necessary for the majority of node-positive patients with VSCC, as the relevant risk of pelvic lymph node involvement was primarily found in node-positive patients with high-grade disease. More, ideally prospective data collections are necessary to validate the relation between inguinal and pelvic lymph node involvement.Key words: vulvar cancer, lymph node metastasis, pelvic lymphadenectomy, recurrence, prognosis     

Evaluation of cytoreductive surgery with pelvic and paraaortic lymphadenectomy and intermittent cisplatin-based combination chemotherapy for improvement of long-term survival in ovarian cancer

The present study was designed in order to assess the therapeutic values of pelvic and paraaortic lymphadenectomy in cytoreductive surgery and intermittent systematic chemotherapy combining cisplatin, doxorubicin, and cyclophosphamide, namely, intermittent PAC for improvement of the long-term prognosis of patients with epithelial ovarian cancer. Intermittent PAC was administered every 3 months over a period of approximately 2 years. One hundred and fifty-five patients with epithelial ovarian cancer were enrolled in the study. The estimated 10-year survival rate of 42 patients with stage I or II ovarian cancer who received pelvic and paraaortic lymphadenectomy and the intermittent PAC was significantly higher than that of 31 patients with the same stages who did not (83.9% vs. 61.1%, p<0.05). Similarly, the estimated 10-year survival rate of 38 patients with stage III or IV ovarian cancer who underwent the above-mentioned treatments was significantly high compared with that of 44 patients in the same advanced stages who did not (60.4% vs. 25.0%, p<0.01). As for pelvic and paraaortic lymphadenectomy, there was no significant difference in the estimated 10-year survival rates between patients with and without retroperitoneal lymph node metastasis. Multivariate analysis revealed that the performance of pelvic and paraaortic lymphadenectomy was the most important factor leading successful clinical remission of the advanced ovarian cancers. Cytoreductive surgery including pelvic and paraaortic lymphadenectomy and to intermittent PAC were thus suggested to be capable of dramatically improving the long-term survival even in advanced epithelial ovarian cancers.     

Inguinal lymph node metastasis: an unusual presentation of fallopian tube carcinoma

OBJECTIVES: Inguinal metastasis is a hitherto unreported presenting feature of fallopian tube adenocarcinoma. CASE: We describe a case of a 69-year-old patient whose first manifestation of fallopian tube adenocarcinoma was an enlarged inguinal lymph node. This was excised and confirmed to be metastatic adenocarcinoma. She was investigated by diagnostic laparoscopy and subsequently underwent laparotomy with total abdominal hysterectomy, omentectomy, and pelvic and para-aortic lymph node dissection. All but two of the lymph nodes extirpated were negative. CONCLUSIONS: Fallopian tube adenocarcinoma may rarely present with metastatic inguinal lymphadenopathy.     

Metastatic serous borderline ovarian tumor in an internal mammary lymph node: a case report and review of the literature.

Background. Reports of supradiaphragmatic involvement of lymph nodes by serous borderline ovarian tumors are rare. Case. We describe the finding of metastatic tumor involving an internal mammary lymph node in a 74-year-old patient with serous borderline ovarian tumor. The positive lymph node was found incidentally during cardiac surgery 7 years after excision of the patient's serous borderline ovarian tumor. The incidence and significance of pelvic, paraaortic, and supradiaphragmatic lymph node involvement among women with borderline ovarian tumors is discussed. Conclusion. Supradiaphragmatic lymph node involvement can occur among women with serous borderline ovarian tumors. Borderline ovarian tumors should be included in the differential diagnosis of metastatic adenocarcinoma involving the supradiaphragmatic lymph nodes.     

Effect of Paraaortic Lymphadenectomy on 5-Year Survival in Early Stage Cervical Cancer

This study includes 278 patients with Stages 1 and 2 cervical cancer subjected to type 3 hysterectomy and lymphadenectomy. The incidence of lymph node metastasis and effect of paraaortic lymphadenectomy on 5-year survival were evaluated. The overall incidences of pelvic and paraaortic lymph node involvement were 24.1% and 8.0%, respectively. The overall 5-year survival rate was 83.8%. The 5-year survival of patients subjected to both pelvic and paraaortic lymphadenectomy was found to be 84.6%; the figure was 80.9% for patients subjected to only pelvic lymphadenectomy. No statistical difference in survival was found between patients with and without paraaortic lymphadenectomy.     

cis-Diamminedichloroplatinum II based combination chemotherapy for the control of extensive paraaortic lymph node metastasis in cervical cancer

A prospective study was carried out in nine consecutive patients with extensive paraaortic lymph node metastasis from locally advanced cervical cancer. Patients were treated with pelvic radiation and weekly cis-platinum during radiation followed by cis-platinum based combination chemotherapy given on a monthly basis. Three weeks after completion of pelvic radiation and weekly cis-platinum, and prior to monthly combination chemotherapy, pelvic examination confirmed a 100% local response rate: 78% complete and 32% partial response. All patients have been followed for greater than or equal to 1 year or until death and only 22% (2) are alive NED while 56% (5) are dead of cervical cancer and 22% (2) are alive with cervical cancer. Although there was a significant response to local pelvic tumor by pelvic radiation and weekly cis-platinum, it is concluded that this protocol would not result in a significant increase in 5-year survival for patients with extensive paraaortic lymph node metastasis, because of the inability to control disease outside of the radiated area.     

卵巢癌腹主动脉旁淋巴结清除术与生存率的关系

目的:探讨上皮性卵巢癌患者行腹主动脉旁淋巴结清除术与其生存预后的关系。方法:回顾分析卵巢癌肿瘤细胞减灭术的80例患者,将其中行腹主动脉旁淋巴结(PAN)+盆腔淋巴结(PLN)清除术分为A组(30例),仅行PLN清除术者分为B组(50例),分析PAN清除与患者生存预后的相关性。结果:行卵巢肿瘤细胞减灭术的80例患者中,32例(40.0%)发生淋巴结转移。A组中19例发生淋巴结转移,其中仅PAN阳性7例,仅PLN阳性3例,PAN和PLN均阳性9例;B组中13例发生PLN转移。A与B组患者的淋巴结转移与临床分期、肿瘤细胞分化程度和组织学类型显著相关(P0.05)。A组中淋巴结转移部位以PAN最多16例,其余依次为髂内、闭孔、髂总、腹股沟及髂外淋巴结。A组患者的3年、5年生存率分别为77.9%和46.7%,均高于B组(69.0%和39.2%),但无显著差异(P0.05)。A与B组患者中转移至PLN者的3年生存率分别是68.5%和41.4%,5年生存率是49.7%和26.4%,两组比较差异显著(P=0.044)。A组患者中淋巴结阳性与阴性患者3年生存率分别为43.5%和72.7%,5年生存率是27.2%和58.5%,差异显著(P=0.048)。Cox模型单因素分析提示,淋巴结状态对患者的生存率有影响(P0.01),而且是死亡风险因素。结论:腹主动脉旁淋巴结的清除对改善卵巢癌患者预后起着重要作用。     

Sentinel node metastasis in the groin detected by technetium-labeled nannocolloid in a patient with cervical cancer

OBJECTIVE: The aim of this study was to describe the first sentinel groin node metastasis detected by technetium-labeled nanocolloid in a patient with cervical carcinoma. METHOD: Preoperatively, 60 mBq technetium-labeled nannocolloid was injected at 3 and 9 o'clock in the uterine cervix. Sentinel nodes were detected using a handheld and laparoscopic probe (Navigator) and removed for pathological assessment. RESULTS: A 52-year-old diagnosed with FIGO stage IIA squamous cervical carcinoma was referred to our unit. On physical examination a bulky cervical tumor and a 1.5-cm enlarged left inguinal lymph node were found. No other abnormalities were seen on pelvic MRI scan and CT scan of the abdomen and lower pelvis. Preoperative lymphoscintigraphy showed that a left groin node and three nodes located in the right obturator fossa were the sentinel nodes. They were easily detected using, respectively, a hand-held and a laparoscopic probe and removed. As both the inguinal and the obturator lymph nodes contained metastatic deposits, the patient was treated with the combination of chemotherapy and radiotherapy. CONCLUSION: Inguinal lymph nodes can rarely be the sentinel nodes in patients with cancer of the uterine cervix.     

Risk factors for early and late postoperative complications of patients with endometrial cancer

OBJECTIVE: We have routinely performed staging with pelvic and/or paraaortic lymphadenectomy in patients with endometrial cancer having moderate to high risk for lymph node metastasis. The aim of this study was to investigate the risk factors for the occurrence of early and late postoperative complications in patients managed primarily by surgery in our institution. STUDY DESIGN: Two-hundred and fifty-nine consecutive cases of endometrial cancer were enrolled in the study. Past history, body mass index, type of surgery, intraoperative findings, and follow-up information were collected from patient charts. Of these, 200, 127, and 30 patients underwent systematic pelvic lymphadenectomy, systematic paraaortic lymphadenectomy, and radical hysterectomy, respectively. The median numbers of dissected pelvic and paraaortic lymph nodes were 32 and 14, respectively. RESULTS: None of the complications resulted in death. Of the study population, 36 early complications and 34 late complications occurred. Overall 65 patients (25.1%) had at least one complication. Multivariate analysis revealed that a longer operative time and paraaortic lymphadenectomy were independent predictors for the occurrence of early and late postoperative complications, respectively. CONCLUSIONS: Since the therapeutic value of lymphadenectomy is still under evaluation, the indications for systematic pelvic and paraaortic lymphadenectomy should be carefully considered.