J Korean Med Sci.  2010 Apr;25(4):552-556. 10.3346/jkms.2010.25.4.552.

Necessity of Radical Hysterectomy for Endometrial Cancer Patients with Cervical Invasion

• Lee TS
• Kim JW
• Kim DY
• Kim YT
• Lee KH
• Kim BG
• McMeekin D

• KMID: 1792924
• DOI: http://doi.org/10.3346/jkms.2010.25.4.552

Abstract

To determine whether radical hysterectomy is necessary in the treatment of endometrial cancer patients with cervical involvement, we reviewed the medical records of women who underwent primary surgical treatment for endometrial carcinoma and selected patients with pathologically proven cervical invasion. Among 133 patients, 62 patients underwent extrafascial hysterectomy (EH) and 71 radical or modified radical hysterectomy (RH). The decision regarding EH or RH was made at the discretion of the attending surgeon. The sensitivity of pre-operative magnetic resonance imaging for cervical invasion was 44.7% (38/85). In RH patients, 10/71 (14.1%) patients had frankly histologic parametrial involvement (PMI). All were stage III or over. Eight of 10 patients had pelvic/paraaortic node metastasis and two showed extrauterine spread. In 74 patients with stage II cancer, RH was performed in 41 and PMI was not seen. Sixty-six (89.2%) patients had adjuvant radiation therapy and there were 3 patients who had developed recurrent disease in the RH group and none in the EH group (Mean follow-up: 51 months). Although these findings cannot conclusively refute or support the necessity of radical hysterectomy in patients with cervical extension, it is noteworthy that the risk of PMI seems to be minimal in patients with a tumor confined to the uterus without evidence of extrauterine spread.

Keyword

Endometrial Neoplasms; Radical Hysterectomy; Cervical Invasion

MeSH Terms

Adult
Aged
Databases, Factual
Endometrial Neoplasms/epidemiology/*pathology/*surgery
Female
Humans
*Hysterectomy/methods
Korea/epidemiology
Middle Aged
Neoplasm Metastasis
Neoplasm Recurrence, Local/pathology
Neoplasm Staging
Radiotherapy, Adjuvant
Retrospective Studies
Treatment Outcome
Uterine Cervical Neoplasms/epidemiology/*pathology/*surgery

Figure

• 

  Fig. 1 The relationship between the depth of myometrial invasion and that of cervical stromal invasion showing a trend that myometrial invasion tends to precede cervical stromal invasion (P=0.001, by chi-square test). EM, endometrium; MM, myometrium.

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