Lymph node counts
LN removal counts provide a way of measuring the adequacy of surgical staging to guide adjuvant therapy and prognosis(5,33). Improved OS is related to a higher number of LNs removed, especially in patients with high and intermediate risk EC(36). Literature shows a wide range of LN removal counts(20,34) suggesting the subjective definition of adequate LND is biased when evaluating its prognostic and therapeutic efficacy. Studies have shown that patients have improved survival when >10–12 LNs were removed(5,33). In contrast one study suggested that 21–25 nodes are required for adequate nodal assessment(38). This was directly opposed by Benedetti et al. showing no improved survival with removal of 20 or more LNs(34). These mixed findings support the ESMO-ESGO-ESTRO 2016 consensus that systematic LND should be defined by removing more than 10 LNs(5). This calls into question the ASTEC trial in which less than 10 LNs were removed in 35% of surgeries(20).