A retrospective cohort study analyzed the results of 671 patients with endometrial carcinoma who had been treated with complete, systematic pelvic lymphadenectomy (n=325 patients) or combined pelvic and para-aortic lymphadenectomy (n=346). Patients at intermediate or high risk of recurrence were offered adjuvant radiotherapy or chemotherapy. Overall survival was significantly longer in the pelvic and para-aortic lymphadenectomy group than in the pelvic lymphadenectomy group (HR 0.53, 95% CI 0.38 to 0.76). This association was also recorded in 407 patients at intermediate (HR 0.43) or high risk (HR 0.50), but overall survival was not related to lymphadenectomy type in low-risk patients. Survival of 328 patients with intermediate or high risk treated with adjuvant radiotherapy or chemotherapy, was improved with pelvic and para-aortic lymphadenectomy (HR 0.48, 0.29 to 0.83) and with adjuvant chemotherapy (HR 0.59, 0.37 to 1.00) independently of one another.