Extraperitoneal laparoscopic para-aortic lymphadenectomy for late isolated para-aortic lymph node recurrence of endometrial cancer

Abstract

Recurrence of uterine cancer peaks at 3 years after treatment, and most cases occur within 5 years. Late recurrence exceeding 10 years is rare, but there have been a few reports of such cases, most of which were isolated recurrences for which surgical resection was chosen. Here, we describe a case in which para-aortic lymphadenectomy was performed with retroperitoneal laparoscopy to confirm a diagnosis of recurrence or metastasis in a para-aortic lymph node 15 years after treatment for uterine cancer. The patient was a 71-year-old woman who had undergone simple abdominal hysterectomy, bilateral salpingo-oophorectomy, and pelvic lymph node dissection for Grade 1 endometrial carcinoma of the uterus, and had received total pelvic irradiation as adjuvant therapy for a diagnosis of Stage IC (FIGO 1988) (pT1cN0M0). A routine examination 15 years after treatment indicated an elevated CA125 level (36.9 mg/dl), and PET-CT showed accumulation in the para-aortic lymph nodes, which led to suspicion of uterine cancer recurrence and referral to our department. Retroperitoneal laparoscopic para-aortic lymphadenectomy was performed for histological diagnosis and complete resection, and histopathological examination revealed recurrence of previous uterine cancer. This case shows that retroperitoneal laparoscopic observation and biopsy are useful as a minimally invasive approach for enlarged para-aortic lymph nodes in patients with suspected late recurrence of uterine cancer.