Objective:

To systematically evaluate the effect of combined pelvic and para-aortic lymphadenectomy (PPaLND) versus pelvic lymphadenectomy alone (PLND) or no lymphadenectomy on overall survival (OS) in patients with endometrial cancer, focusing on risk-stratified subgroup analyses.

Approach:

Key Findings:

• Fourteen studies (1 RCT, 13 retrospective) comprising 25,432 patients were included.
• PPaLND was associated with a significant improvement in OS compared to no lymphadenectomy (HR = 0.61, 95% CI: 0.49–0.75).
• Compared to PLND, PPaLND showed a survival benefit in the overall population (HR = 0.60, 95% CI: 0.44–0.81).
• No statistically significant differences were observed in the intermediate-to-high-risk subgroup when comparing PPaLND to PLND (HR = 0.62, 95% CI: 0.31–1.24).
• Sensitivity analysis revealed significant changes in results for the intermediate-to-high-risk subgroup upon exclusion of specific studies.

Interpretation:

Limitations:

• The observational nature of the evidence limits the robustness of findings.
• The wide confidence intervals in some subgroups indicate very low statistical power.

Conclusion:

Attribution Notice

This content is an AI-generated, fully rewritten summary based on a published scholarly article. It does not reproduce the original text and is not a substitute for the original publication. Readers are encouraged to consult the source for full context, data, and methodology.