Which is the appropriate surgical procedure for Stage I endometrial carcinoma?

Objective: To study the appropriate surgical procedure for Stage I endometrial carcinoma (EC), the clinical and pathological features and prognosis factors, as well as types were analyzed retrospectively. Materials and Methods: This is a retrospective study of 277 patients with early-stage EC in clinical Stages I that received surgery between January 2000 and March 2008. The appropriate surgical procedures were divided into three types (procedure I-III: hysterectomy with or without ovary preservation, subradical hysterectomy plus pelvic lymph node biopsy, and radical hysterectomy pelvic plus lymphadenectomy) according to the clinical stage. Results: Tumor invasion of the cervix and deep muscularis as well as the parametrium, EC Stage Ib, grade 3 and ascites had carcinoma cells, were high-risk factors of EC metastasis to the retroperitoneum (p < 0.05). The ovarian preservation of EC Stage Ia had no effect on overall survival. The three types of procedure for the EC Stage Ia were not correlated significantly to the three-year and five-year survival rates. The three-year and five-year survival rates of three surgical procedures for the EC Stage Ib were significantly correlated. The survival rates of surgical procedures II and III were significantly higher than that of procedure I (P < 0.05). Conclusion: Subradical hysterectomy plus pelvic lymph node biopsy was recommended for EC Stage Ib with high-risk factors. There was no evidence of benefit in terms of overall or recurrence-free survival for radical hysterectomy plus pelvic lymphadenectomy in women with Stage I EC.

Endometrial carcinoma; Stage I; Surgical procedure.

[1] Pecorelli S.: “Revised FIGO staging for carcinoma of the vulva, cervix and endometrium.” Int. J. Gynaecol. Obstet., 2009, 105, 103.

[2] Bakkum-Gamez J.N., Gonzalez-Bosquet J., Laack N.N., Mariani A., Dowdy S.C.: “Current Issues in the Management of Endometrial Cancer”. Mayo Clin. Proc., 2008, 83, 97.

[3] ACOG Practice Bulletin.: “Clinical management guidelines for obstetrician gynecologists, number 65, August 2005: management of endometrial cancer”. Obstet. Gynecol., 2005, 106, 413.

[4] Amant F., Moerman P., Neven P., Timmerman D., Van Limbergen E., Vergote I.: “Endometrial cancer”. Lancet, 2005, 366, 491.

[5] Jemal A., Murray T., Ward E., Samuels A., Tiwari R.C., Ghafoor A., et al: “Cancer statistics, 2005”. CA Cancer J. Clin., 2005, 55, 10.

[6] Papanikolaou A., Kalogiannidis I., Goutzioulis M., Misailidou D., Makedos A., Vergote I., et al.: “Pelvic lymphadenectomy as alternative to postoperative radiotherapy in high risk early stage endometrial cancer”. Arch. Gynecol. Obstet., 2006, 274, 91.

[7] Eltabbakh G.H., Shamonki J., Mount S.L.: “Surgical stage, final grade, and survival of women with endometrial carcinoma whose preoperative endometrial biopsy shows well-differentiated tumors”. Gynecol. Oncol., 2005, 99, 309.

[8] Benedetti Panici P., Basile S., Maneschi F., Alberto Lissoni A., Signorelli M., et al.: “Systematic pelvic lymphadenec-tomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial”. J. Natl. Cancer Inst., 2008, 100, 1707.

[9] Barakat R.R., Lev G., Hummer A.J., Sonoda Y., Chi D.S., Alektiar K. M., et al.: “Twelve-year experience in the management of endometrial cancer: a change in surgical and postoperative radiation

[10] Connor J.P., Andrews J.I., Anderson B., Buller R.E.: ”Computed tomography in endometrial carcinoma”. Obstet. Gynecol., 2000, 95, 692.

[11] Creutzberg C.L.: “GOG-99: ending the controversy regarding pelvic radiotherapy for endometrial carcinoma [editorial]”? Gynecol. Oncol., 2004, 92, 740-3.

[12] Wright J.D., Buck A.M., Shah M., Burke W.M., Schiff P.B., Herzog T. J.: “Safety of ovarian preservation in premenopausal women with endometrial cancer”. J. Clin. Oncol., 2009, 27, 1214.

[13] Lee T.S., Jung J.Y., Kim J.W., Park N.H., Song Y.S., Kang S.B., et al.: “Feasibility of ovarian preservation in patients with early stage endometrial carcinoma”. Gynecol. Oncol., 2007, 104, 52.

[14] Shuster L.T., Gostout B.S., Grossardt B.R., Rocca W.A.: “Prophy-lactic oophorectomy in premenopausal women and long-term health - a review”. Menopause Int., 2008, 14, 111.

[15] Frumovitz M., Singh D.K., Meyer L., Smith D.H., Wertheim I., Resnik E., et al.: “Predictors of final histology in patients with endometrial cancer”. Gynecol. Oncol., 2004, 95, 463.

[16] Frumovitz M., Slomovitz B.M., Singh D.K., Broaddus R.R., Abrams J., Sun C.C., et al.: “Frozen section analyses as predictors of lymphatic spread in patients with early-stage uterine cancer”. J. Am. Surg., 2004, 199, 388-93.

[17] Nofech-Mozes S., Ackerman I., Ghorab Z., Ismiil N., Thomas G., Covens A., et al.: “Lymphovascular Invasion Is a Significant Predictor for Distant Recurrence in Patients With Early-Stage”. Am. J. Clin. Pathol., 2008, 129, 912.

[18] Creutzberg C.L., van Putten W.L., Koper P.C., Lybeert M.L., Jobsen J. J., Wárlám-Rodenhuis C.C., et al.: “Surgery and postoperative radiotherapy versus surgery alone for patients with stage-1 endometrial carcinoma: multicentre randomised trial. PORTEC Study Group. Post Operative Radiation Therapy in Endometrial Carci- noma”. Lancet, 2000, 355, 1404.

[19] Solhjem M.C., Petersen I.A., Haddock M.G.: “Vaginal brachytherapy alone is sufficient adjuvant treatment of surgical stage I endometrial cancer”. Int. J. Radiat. Oncol. Biol. Phys., 2005, 62, 1379.

[20] Lachance J.A., Stukenborg G.J., Schneider B.F., Rice L.W., Jazaeri A.A.: “A cost-effective analysis of adjuvant therapies for the treatment of stage I endometrial adenocarcinoma”. Gynecol. Oncol., 2008, 108, 77.

[21] Mariani A., Webb M.J., Keeney G.L., Haddock M.G., Calori G., Podratz K.C.: “Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am. J. Obstet. Gynecol., 2000, 182, 1506.

[22] Kim K., Ryu S.Y.: ”Major clinical research advances in gynecologic cancer 2009”. J. Gynecol. Oncol., 2009, 20, 203.

[23] Thomas M.B., Mariani A., Cliby W.A., Keeney G.L., Podratz K.C., Dowdy S.C.: “Role of cytoreduction in stage III and IV uterine papillary serous carcinoma”. Gynecol. Oncol., 2007, 107, 190-3.

[24] Barakat R.R., Lev G., Hummer A.J., Sonoda Y., Chi D.S., Alektiar K.M., et al.: “Twelve-year experience in the management of endometrial cancer: a change in surgical and postoperative radiation approaches”. Gynecol. Oncol., 2007, 105, 150.

[25] Kong A., Simera I., Collingwood M., Williams C., Kitchener H.: “Adjuvant radiotherapy for stage I endometrialcancer: systematic review and meta-analysis”. Ann. Oncol., 2007, 18, 1595.