Low risk group
The ESMO-ESGO-ESTRO 2016 recommendations state no therapeutic benefit of
LND for low-risk EC patients (Table 3). These recommendations are based
on a study by Benedetti et al.(34), which concluded
that systematic pelvic LND did not improve 5 year disease free survival
(DFS) or overall survival (OS). However, these recommendations are
limited as this RCT did not risk stratify their patient cohort. The
second RCT was the ASTEC trial(20). The “low-risk”
group was defined as FIGO 1988 IA or IB and G1 and G2, which differs
from the current ESMO-ESGO-ESTRO 2016 classification (Table 3). Results
showed no survival benefit (OS and recurrence-free survival (RFS)) of
pelvic LND in “low-risk” patients. In this trial, para-aortic node
sampling was at the discretion of the surgeon, and in patients with
anaesthetic concern or obesity, the surgeon may have omitted dissection
of some LNs. A reduced number of lymph nodes dissected is a significant
predictor of progression free survival (PFS) and
OS(5,21). These significant limitations may have
contributed to the lack of therapeutic benefit shown, mistakenly
supporting ESMO-ESGO-ESTRO 2016 recommendations. Additionally, a
meta-analysis of seven observational studies(21)showed limited survival benefit with LND in low risk patients.