What is the importance of omental metastasis in patients with endometrial cancer?

Abstract

Objective: To identify surgico-pathologic factors, survival, and the factors determining survival in patients with omental metastasis from endometrial cancer. Material and Methods:Patients with endometrial cancer operated on between 1993-2012 in our hospital and who had omental metastases were included. Patients with either uterine sarcoma or synchronous tumors were excluded.Results: Omentectomy was performed in 811 patients with endometrial cancer, and omental metastasis was found in 48 (5.9%) patients.Tumor type was endometrioid cancer in 26 patients. Omental metastasis was macroscopic and microscopic in 60% and 40% of the patients, respectively. Total omentectomy increased the chance of detection of the microscopic metastases. Among the patients with omental metastasis, 68.8% had positive peritoneal cytology, 66.7% had adnexal involvement, 60.5% had metastases in the lymph nodes, 47.9% had cervical involvement, and 29.2% had serosal involvement; 43.8% of these patients had intra-abdominal spread beyond the omentum, adnexa, and peritoneal cytology. Two-year disease-free survival (DFS) was 28.2%, and 2-y overall survival (OS) was 40%. The depth of myometrial invasion, grade, cytology, and status of pelvic lymph nodes affected 2-y DFS, while cervical invasion and cytology affected 2-y OS. Conclusion:Omental metastasis in endometrial cancer means poor prognosis, and two-thirds of these patients are lost at the end of the second year. Although total omentectomy increases the chance of the detection of micrometastases, its effect on survival is controversial. New treatment modalities are necessary in this patient group. (J Turk Ger Gynecol Assoc 2014; 15: 164-72) Key words: Endometrial cancer, omental metastases, survival Received: 03 June, 2014 Accepted: 25 July, 2014 What is the importance of omental metastasis in patients with endometrial cancer? Abstract of patients involving all stage IV patients. Patients without other intra-abdominal metastases and patients with microscopic omental metastases were included in these studies. The reports, except the studies mentioned above, were presented as very small case series or case reports. The patients with omental metastases were not analyzed with regard to surgico-pathologic characteristics and survival, and the factors determining survival have not been identified sufficiently in endometrial cancer. In this study, the determination of surgico-pathologic factors, survival, and the factors determining survival in patients with omental metastases from endometrial cancer is aimed. Material and Methods Study PopulationThe records and pathologic reports of patients with endometrial cancer who were operated in our clinic between 1993 and 2012 were analyzed retrospectively. The patients with omental metastasis were included. Patients with uterine sarcoma, endometrioid carcinoma involving a sarcoma component, or synchronous tumors were excluded. The data related to demographic characteristics, intraoperative findings, debulking status, surgico-pathologic results, pat...

Case Report: Ductal Breast Cancer with Endometrial Metastases

“…In their prospective report of 134 patients with clinical stage-1 endometrioid adenocarcinoma of the endometrium, Fujiwara, et al [13] proposed the removal of at least 10 × 5 cm of omentum for adequate detection of metastasis or a complete omentectomy if gross metastasis was suspected [13]. Turan, et al [14] studied 811 endometrial cancer patients and found that total omentectomy vs. infracolic omentectomy significantly increased the odds of detecting microscopic metastasis (11.3% vs. 2.1%, P < 0.001) [14].…”

Prognostic significance of omental disease and the role of omentectomy in non-endometrioid endometrial cancer

“…Saygili et al strongly recommended histopathologic examination, whereas Fujiwara et al stated that this was not necessary and that inspection would be sufficient [12,16]. However, there is no randomized controlled study on this subject and it has not been proven that total omentectomy contributes to survival [6]. Turan et al found no difference in survival in relation to the presence of micrometastases and macrometastases [6].…”

“…In the surgical treatment of endometrial cancer, omentectomy has been the topic of ongoing discussion for several years [2]. Significance and benefits of omentectomy in the surgical staging of EC are not well understood [6]. Due to the relatively low incidence of non-endometrioid tumors, outcomes for patients with these histologic subtypes are scarce.…”

A rare case of grade 1 endometrioid adenocarcinoma of the uterus with omental metastasis with brenner tumor of the ovary in a postmenopausal female

“…Omental metastases are observed in 2.4%–8.3% of patients with endometrial cancer, and it is associated with a poor prognosis. [ 5 ] All guidelines for the treatment of endometrial cancer recommend omentectomy for visible peritoneal dissemination or in cases when the histology is papillary serous, clear cell, or carcinosarcoma. [ 2 ] However, omentectomy is not routinely recommended when the histology is endometrioid adenocarcinoma in the absence of macroscopic intra-abdominal metastases.…”

“…Omentectomy in the presence of metastases may not improve the outcome as shown by Turan et al , who concluded that although omental metastases were associated with a poor prognosis, the effect of omentectomy on survival was controversial. [ 5 ] Turan et al performed omentectomy in 811 women with endometrial cancer, and omental metastases were present in 48 patients (5.9%), of whom 26 women had endometrioid carcinoma. Omental metastases were macroscopic in 60% patients and microscopic in 40% of the patients.…”