Should presacral lymph nodes be included in a locally advanced endometrial cancer without cervical involvement with incomplete surgical staging (i.e. no lymph node dissection)?

The pattern of spread for lymphatics draining the uterus tend to follow a predictable pattern generally along one of two primary pathways. Lymph flows from the fundus toward the adnexa and infundibulopelvic ligaments, placing the lower para-aortic lymph node stations as a potential site for spread. The middle and lower third of the uterus spread along the round ligament and to the lateral pelvic side wall, specifically implicating the external iliac lymph nodes and most commonly the obturator lymph nodes. In general, the presacral lymph nodes are not considered to be a direct drainage pathway from the uterine corpus.

The presacral lymph nodes lie sandwiched between the posterior aspect of the mesorectal fascia and anterior to the sacrum, ...