J Gynecol Oncol.  2015 Apr;26(2):125-133. 10.3802/jgo.2015.26.2.125.

Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer

• Arsene E
• Bleu G
• Merlot B
• Boulanger
• Vinatier D
• Kerdraon O
• Collinet P

• KMID: 2160795
• DOI: http://doi.org/10.3802/jgo.2015.26.2.125

Abstract

OBJECTIVE
Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery.
METHODS
This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied.
RESULTS
Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1+/-117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications.
CONCLUSION
Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.

Keyword

Complications; Endometrial Neoplasms; Lymph Node Excision; Retrospective Studies; Risk Factors

MeSH Terms

Aged
Carcinoma, Endometrioid/epidemiology/pathology/*surgery
Endometrial Neoplasms/epidemiology/pathology/*surgery
Female
Humans
*Hysterectomy/methods/statistics & numerical data
Lymph Node Excision/*methods/standards/statistics & numerical data
Middle Aged
Morbidity
Neoplasm Staging/standards
Pelvis
Postoperative Complications/epidemiology
Prognosis
Reoperation/statistics & numerical data
Retrospective Studies
*Salpingectomy/methods/statistics & numerical data

Figure

• 

  Fig. 1 Flow diagram for patient's management after 2010. EEC, endometrioid endometrial cancer.

• 

  Fig. 2 Flow chart of patients with endometrioid endometrial cancer (EEC) of the period 2 (2011 to 2013).

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