Lymph node targets
LND in EC patients can include different LN targets. Mariani et al. reported the potential therapeutic role of pelvic and paraaortic LND in node positive low risk patients with EC(47). Of the node positive patients, 84% had pelvic LN metastases and 67% had para-aortic node metastases. They concluded that there is a need for systematic pelvic and para-aortic LND. This finding is supported by a study which investigated the anatomical pattern of LN metastases in patients with high-risk early or advanced EC(48). Patients underwent systematic pelvic and para-aortic LND and LNs were histologically assessed. It was found that 18% of patients had positive pelvic nodes, 14.8% had positive para-aortic nodes, and 3.1% had isolated positive para-aortic nodes. Despite the low prevalence, special attention is warranted for the latter group to avoid possible misdiagnosis in stage I-II EC(24). This distribution of positive nodes indicates that LND, if performed, should contain both pelvic and para-aortic nodes up to the renal vessels for an accurate assessment of all potentially positive nodes(5,48). Previous studies assessing the efficacy of LND as a treatment did not include para-aortic nodes(20).