Is Complete Surgical Staging Necessary in Clinically Early-Stage Endometrial Carcinoma?

Abstract

The purpose of this study was to evaluate the incidence of pelvic/para-aortic node metastases and the other pathological characteristics from medical records of patients with endometrial carcinoma treated at King Chulalongkorn Memorial Hospital, Bangkok, Thailand, between 1996 and 2005. The records of 213 patients with endometrial carcinoma who had complete surgical staging were reviewed. A particular focus was on clinically early-stage disease. Clinical staging could be determined in 206 patients. Of the 206 patients, 182 (88.3%) presented with clinical stage I disease. However, only 142 (78%) of these patients were confirmed as surgical stage I and 22% were upstaged. Preoperative histologic grade was diagnosed inaccurately in 15.9% of patients and 7.7% were upgraded. Of patients with preoperative histologic grade 1, 33% had deep myometrial invasion, 8.2% had pelvic node metastasis, and 3.3% had para-aortic node metastasis. Even in clinical stage IaG1, pelvic node metastasis occurred in 5.6% and para-aortic node metastasis in 1.3%. It has been suggested that complete surgical staging may not be necessary in patients with low-risk endometrial carcinoma who have disease limited to the uterus without grade 3 or deep myometrial invasion. However, proper selection of such low-risk patients remains problematic. In situations where there is limited preoperative and intraoperative assessment of high-risk factors, particularly radiographic imaging and frozen section assessment, the role of complete surgical staging is beneficial.

Intraoperative frozen section is essential for assessment of myometrial invasion but not for histologic grade confirmation in endometrial cancer: a ten-year experience

“…Myometrial invasion and histological grade are the most important prognostic indicators in endometrial cancer, with a good correlation with the prevalence of lymph node metastases and with patient survival. Tumor grade is the most commonly used prognostic factor that guides surgical planning [6]. In the PORTEC randomized trial, stage I patients (excluding stage I C grade 3 patients) operated without performing lymphadenectomy were randomized to receive pelvic radiotherapy or no treatment, with no diVerence in global survival and in endometrial cancer-related death, with a justiWed morbidity [7].…”

An Experimental Lymphoscintigraphy Study in an Acute Unilateral Deep Venous Thrombosis Model

“…9,10 In a previous report, the rate of lymphedema complication in a group of patients who underwent pelvic and para-aortic lymphadenectomy for gynecologic malignancies was found to be 24%. 11 The same researchers suggested that if the surgical approach could be modified, the severity of lymphedema might be reduced.…”

Survival benefits of pelvic lymphadenectomy versus pelvic and para-aortic lymphadenectomy in patients with endometrial cancer

“…[ 21 ] Previous studies have emphasized that the detection of occult lymph node metastasis was important for predicting prognosis, showing that 4.1% to 5.6% of the patients with low-risk endometrial cancer may have lymph node metastasis on the final histologic reports. [ 22 , 23 ] In patients with intermediate- or high-risk endometrial cancer, lymph node metastasis was observed in 21.9% of the patients, of which, para-aortic lymph node involvement rate up to 15%. [ 21 ] Moreover, a growing number of studies found that the skip metastasis, namely isolated para-aortic lymph node metastasis in the setting of negative pelvic nodes, has been reported in less than 5% of patients but mostly associated with risk factors for lymph node involvement.…”