The role of omentectomy in the surgical treatment of uterine serous carcinoma

Abstract

Objective The aims of this study were to assess the role of omentectomy in the staging of uterine serous carcinoma (USC) and to evaluate its impact on patient outcomes. Study design Patients diagnosed with USC at the First Affiliated Hospital of Sun Yat-sen University of China were retrospectively reviewed. The clinicopathological characteristics and survival data of 187 patients were analyzed. Risk factors for omental metastasis were evaluated. Kaplan–Meier survival curves were used to compare survival status and the presence of omental metastasis. Results We found that 35 of 187 patients (18.7%) had omental metastases. Omental metastasis was significantly associated with adnexal involvement (40.0% vs 19.1%, P = 0.008, OR 2.828, 95% CI 1.286–6.218). Multivariate analysis showed that in addition to lymph node metastases and suboptimal surgery, omental metastasis in USC remained an independent predictor of decreased PFS and OS (PFS, HR 1.48, 95% CI 1.14–4.63, P = 0.024; OS, HR 1.39, 95% CI 1.04–3.60, P = 0.043). Conclusions The incidence of omental metastasis is not low in patients with USC. Visual assessment and omental biopsy may be insufficient for recognizing occult metastases. Omentectomy should be part of the staging surgery in USC patients because it provides additional information about survival. Prospective studies are needed to confirm these results.

Range of Resection in Endometrial Cancer—Clinical Issues of Made-to-Measure Surgery

“…The reported overall rate of positive lymph nodes in EC was 5-9% in the entire cohort and 20-29% in the high-risk group [51,52]. Among the patients with positive lymph nodes, about a half had both pelvic and para-aortic involvement [60].…”

High-grade endometrial carcinoma limited to the endometrium or a polyp: is adjuvant treatment necessary?

“…However, recent publications have shown that the detection of microscopic disease in normal-appearing omentum is rare in uterine serous carcinoma. 21 Although a recent study showed that the occurrence of omental metastases in patients with serous intraepithelial carcinoma varied from 5.1% to 9.8%, 22 adnexal involvement was found to be an important risk factor associated with omental involvement. 22 Hui et al also showed that when the omentum is involved, it is usually macroscopic disease or there is evidence of metastases elsewhere.…”

“…21 Although a recent study showed that the occurrence of omental metastases in patients with serous intraepithelial carcinoma varied from 5.1% to 9.8%, 22 adnexal involvement was found to be an important risk factor associated with omental involvement. 22 Hui et al also showed that when the omentum is involved, it is usually macroscopic disease or there is evidence of metastases elsewhere. 23 Implications for Practice and Future Research Although this study was not meant to be a thorough literature review, we identified the largest studies on endometrial carcinoma limited to a polyp or the endometrium.…”

Current Approaches to the Management of Patients with Endometrial Cancer

“…It is suggested, though, that cytology of the peritoneal fluid should not be routinely performed, as positive results could be attributed to uterus handling. For some high-grade histological types of non-endometrioid EC, such as clear cell or serous carcinoma, and carcinosarcoma, omentectomy should be included in the surgical procedure, as visual assessment of the omentum appears to be insufficient [ 1 , 49 , 50 ]. When complete or optimal cytoreduction is attained, OS and progression-free survival (PFS) appear to be longer [ 51 ].…”