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Early-Stage Endometrial Cancer: Surgery

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Uterine Cancer

Part of the book series: Current Clinical Oncology ((CCO))

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Abstract

Endometrial cancer typically presents at an early stage, and surgery alone can be curative in many of these cases. Traditionally, surgery for early-stage disease has been carried out using an open approach; however, the use of minimally invasive surgery has rapidly grown in the field of gynecologic oncology. Multiple studies have demonstrated its feasibility, and oncologic outcomes continue to be validated.

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References

  1. Siegel R, Miller K, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.

    Article  Google Scholar 

  2. Kurman RJ, Zaino RJ, Norris HJ. Endometrial carcinoma. In: Kurman RJ, editor. Blaustein’s pathology of the female genital tract. 4th ed. New York, NY: Springer; 1994. p. 439–86.

    Chapter  Google Scholar 

  3. Murali R, Soslow RA, Weigelt B. Classification of endometrial carcinoma: more than two types. Lancet Oncol. 2014;15(7):e268–78.

    Article  Google Scholar 

  4. Sood AK, Buller RE, Burger RA, Dawson JD, Sorosky JI, Berman M. Value of preoperative CA 125 level in the management of uterine cancer and prediction of clinical outcome. Obstet Gynecol. 1997;90(3):441–7.

    Article  CAS  Google Scholar 

  5. Creasman WT, Morrow CP, Bundy BN, Homesley HD, Graham JE, Heller PB. Surgical pathologic spread patterns of endometrial cancer. A Gynecologic Oncology Group study. Cancer. 1987;60(8 Suppl):2035–41.

    Article  CAS  Google Scholar 

  6. Mariani A, Dowdy SC, Keeney GL, Long HJ, Lesnick TG, Podratz KC. High-risk endometrial cancer subgroups: candidates for target-based adjuvant therapy. Gynecol Oncol. 2004;95:120–6.

    Article  Google Scholar 

  7. Obermair A, Geramou M, Gucer F, et al. Endometrial cancer: accuracy of the finding of a well differentiated tumor at dilatation and curettage compared to the findings at subsequent hysterectomy. Int J Gynecol Cancer. 1999;9(5):383–6.

    Article  Google Scholar 

  8. Daniel AG, Peters 3rd WA. Accuracy of office and operating room curettage in the grading of endometrial carcinoma. Obstet Gynecol. 1988;71(4):612–4.

    CAS  PubMed  Google Scholar 

  9. Ben-Shachar I, Pavelka J, Cohn DE, et al. Surgical staging for patients presenting with grade 1 endometrial carcinoma. Obstet Gynecol. 2005;105(3):487–93.

    Article  Google Scholar 

  10. Larson DM, Johnson KK, Broste SK, Krawisz BR, Kresl JJ. Comparison of D&C and office endometrial biopsy in predicting final histopathologic grade in endometrial cancer. Obstet Gynecol. 1995;86(1):38–42.

    Article  CAS  Google Scholar 

  11. Goff BA, Rice LW. Assessment of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol. 1990;38(1):46–8.

    Article  CAS  Google Scholar 

  12. Fanning J, Tsukada Y, Piver MS. Intraoperative frozen section diagnosis of depth of myometrial invasion in endometrial adenocarcinoma. Gynecol Oncol. 1990;37(1):47–50.

    Article  CAS  Google Scholar 

  13. Frumovitz M, Singh DK, Meyer L, et al. Predictors of final histology in patients with endometrial cancer. Gynecol Oncol. 2004;95(3):463–8.

    Article  Google Scholar 

  14. Arango HA, Hoffman MS, Roberts WS, DeCesare SL, Fiorica JV, Drake J. Accuracy of lymph node palpation to determine need for lymphadenectomy in gynecologic malignancies. Obstet Gynecol. 2000;95(4):553–6.

    CAS  PubMed  Google Scholar 

  15. Eltabbakh GH. Intraoperative clinical evaluation of lymph nodes in women with gynecologic cancer. Am J Obstet Gynecol. 2001;184(6):1177–81.

    Article  CAS  Google Scholar 

  16. Girardi F, Petru E, Heydarfadai M, Haas J, Winter R. Pelvic lymphadenectomy in the surgical treatment of endometrial cancer. Gynecol Oncol. 1993;49(2):177–80.

    Article  CAS  Google Scholar 

  17. Trimble EL, Kosary C, Park RC. Lymph node sampling and survival in endometrial cancer. Gynecol Oncol. 1998;71(3):340–3.

    Article  CAS  Google Scholar 

  18. ACOG. Practice bulletin #149. Endometrial cancer. Obstet Gynecol. 2015;125:1006–26.

    Article  Google Scholar 

  19. Kilgore LC, Partridge EE, Alvarez RD, et al. Adenocarcinoma of the endometrium: survival comparisons of patients with and without pelvic node sampling. Gynecol Oncol. 1995;56(1):29–33.

    Article  CAS  Google Scholar 

  20. Cragun JM, Havrilesky LJ, Calingaert B, et al. Retrospective analysis of selective lymphadenectomy in apparent early-stage endometrial cancer. J Clin Oncol. 2005;23(16):3668–75.

    Article  Google Scholar 

  21. Fanning J, Nanavati PJ, Hilgers RD. Surgical staging and high dose rate brachytherapy for endometrial cancer: limiting external radiotherapy to node-positive tumors. Obstet Gynecol. 1996;87(6):1041–4.

    Article  CAS  Google Scholar 

  22. Orr Jr JW, Holimon JL, Orr PF. Stage I corpus cancer: is teletherapy necessary? Am J Obstet Gynecol. 1997;176(4):777–88.

    Article  Google Scholar 

  23. Larson DM, Broste SK, Krawisz BR. Surgery without radiotherapy for primary treatment of endometrial cancer. Obstet Gynecol. 1998;91(3):355–9.

    Article  CAS  Google Scholar 

  24. Mohan DS, Samuels MA, Selim MA, et al. Long-term outcomes of therapeutic pelvic lymphadenectomy for stage I endometrial adenocarcinoma. Gynecol Oncol. 1998;70(2):165–71.

    Article  CAS  Google Scholar 

  25. Seago DP, Raman A, Lele S. Potential benefit of lymphadenectomy for the treatment of node-negative locally advanced uterine cancers. Gynecol Oncol. 2001;83(2):282–5.

    Article  CAS  Google Scholar 

  26. Berclaz G, Hanggi W, Kratzer-Berger A, Altermatt HJ, Greiner RH, Dreher E. Lymphadenectomy in high risk endometrial carcinoma stage I and II: no more morbidity and no need for external pelvic radiation. Int J Gynecol Cancer. 1999;9(4):322–8.

    Article  Google Scholar 

  27. Yabushita H, Shimazu M, Yamada H, et al. Occult lymph node metastases detected by cytokeratin immunohistochemistry predict recurrence in node-negative endometrial cancer. Gynecol Oncol. 2001;80(2):139–44.

    Article  CAS  Google Scholar 

  28. Fanning S, Firestein S. Prospective evaluation of the morbidity of complete lymphadenectomy in endometrial cancer. Int J Gynecol Cancer. 1998;8:270–3.

    Article  Google Scholar 

  29. Benedetti-Panici P, Maneschi F, Cutillo G, et al. Anatomical and pathological study of retroperitoneal nodes in endometrial cancer. Int J Gynecol Cancer. 1998;8:322–7.

    Article  Google Scholar 

  30. Lutman CV, Havrilesky LJ, Cragun JM, et al. Pelvic lymph node count is an important prognostic variable for FIGO stage I and II endometrial carcinoma with high-risk histology. Gynecol Oncol. 2006;102(1):92–7.

    Article  Google Scholar 

  31. Benedetti Panici P, Basile S, Maneschi F, Alberto Lissoni A, Signorelli M, Scambia G, Angioli R, Tateo S, Mangili G, Katsaros D, Garozzo G, Campagnutta E, Donadello N, Greggi S, Melpignano M, Raspagliesi F, Ragni N, Cormio G, Grassi R, Franchi M, Giannarelli D, Fossati R, Torri V, Amoroso M, Crocè C, Mangioni C. Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst. 2008;100(23):1707–16.

    Article  Google Scholar 

  32. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK. Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet. 2009;373(9658):125–36. Erratum in: Lancet. 2009; 373(9677): 1764.

    Article  Google Scholar 

  33. Burke TW, Levenback C, Tornos C, Morris M, Wharton JT, Gershenson DM. Intraabdominal lymphatic mapping to direct selective pelvic and paraaortic lymphadenectomy in women with high-risk endometrial cancer: results of a pilot study. Gynecol Oncol. 1996;62(2):169–73.

    Article  CAS  Google Scholar 

  34. Holub Z, Kliment L, Lukac J, Voracek J. Laparoscopically-assisted intraoperative lymphatic mapping in endometrial cancer: preliminary results. Eur J Gynaecol Oncol. 2001;22(2):118–21.

    CAS  PubMed  Google Scholar 

  35. Pelosi E, Arena V, Baudino B, et al. Pre-operative lymphatic mapping and intra-operative sentinel lymph node detection in early stage endometrial cancer. Nucl Med Commun. 2003;24(9):971–5.

    Article  CAS  Google Scholar 

  36. Niikura H, Okamura C, Utsunomiya H, et al. Sentinel lymph node detection in patients with endometrial cancer. Gynecol Oncol. 2004;92(2):669–74.

    Article  Google Scholar 

  37. Raspagliesi F, Ditto A, Kusamura S, et al. Hysteroscopic injection of tracers in sentinel node detection of endometrial cancer: a feasibility study. Am J Obstet Gynecol. 2004;191(2):435–9.

    Article  Google Scholar 

  38. Abu-Rustum NR, Khoury-Collado F, Pandit-Taskar N, Soslow RA, Dao F, Sonoda Y, Levine DA, Brown CL, Chi DS, Barakat RR, Gemignani ML. Sentinel lymph node mapping for grade 1 endometrial cancer: is it the answer to the surgical staging dilemma? Gynecol Oncol. 2009;113(2):163–9.

    Article  Google Scholar 

  39. Ballester M, Dubernard G, Lécuru F, Heitz D, Mathevet P, Marret H, Querleu D, Golfier F, Leblanc E, Rouzier R, Daraï E. Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol. 2011;12(5):469–76.

    Article  Google Scholar 

  40. Barlin JN, Khoury-Collado F, Kim CH, Leitao Jr MM, Chi DS, Sonoda Y, Alektiar K, DeLair DF, Barakat RR, Abu-Rustum NR. The importance of applying a sentinel lymph node mapping algorithm in endometrial cancer staging: beyond removal of blue nodes. Gynecol Oncol. 2012;125(3):531–5.

    Article  Google Scholar 

  41. Leitao Jr MM, Khoury-Collado F, Gardner G, Sonoda Y, Brown CL, Alektiar KM, Hensley ML, Soslow RA, Barakat RR, Abu-Rustum NR. Impact of incorporating an algorithm that utilizes sentinel lymph node mapping during minimally invasive procedures on the detection of stage IIIC endometrial cancer. Gynecol Oncol. 2013;129(1):38–41.

    Article  Google Scholar 

  42. Abu-Rustum NR, Khoury-Collado F, Gemignani ML. Techniques of sentinel lymph node identification for early-stage cervical and uterine cancer. Gynecol Oncol. 2008;111(2 Suppl):S44–50.

    Article  Google Scholar 

  43. Jewell EL, Huang JJ, Abu-Rustum NR, Gardner GJ, Brown CL, Sonoda Y, Barakat RR, Levine DA, Leitao Jr MM. Detection of sentinel lymph nodes in minimally invasive surgery using indocyanine green and near-infrared fluorescence imaging for uterine and cervical malignancies. Gynecol Oncol. 2014;133(2):274–7.

    Article  Google Scholar 

  44. Partridge EE, Jessup JM, Donaldson ES, et al. 1996 Patient care evaluation study (PCE) of cancer of the corpus uteri. National cancer database (NCDB), American college of surgery. Gynecol Oncol. 1999;72(3):445.

    Google Scholar 

  45. Society of Gynecologic Oncologists. Referral guidelines in gynecologic oncology. Gynecol Oncol. 2000;78:S1–13.

    Article  Google Scholar 

  46. Chan JK, Lin YG, Monk BJ, Tewari K, Bloss JD, Berman ML. Vaginal hysterectomy as primary treatment of endometrial cancer in medically compromised women. Obstet Gynecol. 2001;97:707–11.

    CAS  PubMed  Google Scholar 

  47. Childers JM, Brzechffa PR, Hatch KD, Surwit EA. Laparoscopically assisted surgical staging (LASS) of endometrial cancer. Gynecol Oncol. 1993;51(1):33–8.

    Article  CAS  Google Scholar 

  48. Eltabbakh GH, Shamonki MI, Moody JM, Garafano LL. Laparoscopy as the primary modality for the treatment of women with endometrial carcinoma. Cancer. 2001;91(2):378–87.

    Article  CAS  Google Scholar 

  49. Homesley HD, Boike G, Spiegel GW. Feasibility of laparoscopic management of presumed stage I endometrial carcinoma and assessment of accuracy of myoinvasion estimates by frozen section: a gynecologic oncology group study. Int J Gynecol Cancer. 2004;14(2):341–7.

    Article  CAS  Google Scholar 

  50. Magriña JF, Mutone NF, Weaver AL, Magtibay PM, Fowler RS, Cornella JL. Laparoscopic lymphadenectomy and vaginal or laparoscopic hysterectomy with bilateral salpingo-oophorectomy for endometrial cancer: morbidity and survival. Am J Obstet Gynecol. 1999;181(2):376–81.

    Article  Google Scholar 

  51. Gil-Moreno A, Diaz-Feijoo B, Morchon S, Xercavins J. Analysis of survival after laparoscopic-assisted vaginal hysterectomy compared with the conventional abdominal approach for early-stage endometrial carcinoma: A review of the literature. J Minim Invasive Gynecol. 2006;13(1):26–35.

    Article  Google Scholar 

  52. Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy for endometrial cancer: patterns of recurrence and survival. Gynecol Oncol. 2004;92(3):789–93.

    Article  Google Scholar 

  53. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS, et al. Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol. 2009;27:5331–6.

    Article  Google Scholar 

  54. Walker JL, Piedmonte MR, Spirtos NM, et al. Recurrence and survival after random assignment to laparoscopy versus laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group LAP2 study. J Clin Oncol. 2012;30:695–700.

    Article  Google Scholar 

  55. Kornblith AB, Huang HQ, Walker JL, Spirtos NM, Rotmensch J, Cella D. Quality of life of patients with endometrial cancer undergoing laparoscopic International Federation of Gynecology and Obstetrics staging compared with laparotomy: a Gynecologic Oncology Group study. J Clin Oncol. 2009;27:5337–42.

    Article  Google Scholar 

  56. Gemignani ML, Curtin JP, Zelmanovich J, Patel DA, Venkatraman E, Barakat RR. Laparoscopic-assisted vaginal hysterectomy for endometrial cancer: clinical outcomes and hospital charges. Gynecol Oncol. 1999;73(1):5–11.

    Article  CAS  Google Scholar 

  57. Frumovitz M, Ramirez PT, Greer M, Gregurich MA, Wolf J, Bodurka DC, Levenback C. Laparoscopic training and practice in gynecologic oncology among Society of Gynecologic Oncologists members and fellows-in-training. Gynecol Oncol. 2004;94(3):746–53.

    Article  Google Scholar 

  58. Mabrouk M, Frumovitz M, Greer M, Sharma S, Schmeler KM, Soliman PT, Ramirez PT. Trends in laparoscopic and robotic surgery among gynecologic oncologists: A survey update. Gynecol Oncol. 2009;112(3):501–5.

    Article  Google Scholar 

  59. Conrad LB, Ramirez PT, Burke W, Naumann RW, Ring KL, Munsell MF, Frumovitz M. Role of minimally invasive surgery in gynecologic oncology: An updated survey of members of the society of gynecologic oncology. Int J Gynecol Cancer. 2015;25(6):1121–7.

    Article  Google Scholar 

  60. Gaia G, Holloway RW, Santoro L, Ahmad S, Di Silverio E, Spinillo A. Robotic-assisted hysterectomy for endometrial cancer compared with traditional laparoscopic and laparotomy approaches: a systematic review. Obstet Gynecol. 2010;116(6):1422–31.

    Article  Google Scholar 

  61. Leitao Jr MM, Bartashnik A, Wagner I, et al. Cost-effectiveness analysis of robotically assisted laparoscopy for newly diagnosed uterine cancers. Obstet Gynecol. 2014;123:1031–7.

    Article  Google Scholar 

  62. Boente MP, Yordan Jr EL, McIntosh DG, et al. Prognostic factors and long-term survival in endometrial adenocarcinoma with cervical involvement. Gynecol Oncol. 1993;51(3):316–22.

    Article  CAS  Google Scholar 

  63. Mariani A, Webb MJ, Keeney GL, Calori G, Podratz KC. Role of wide/radical hysterectomy and pelvic lymph node dissection in endometrial cancer with cervical involvement. Gynecol Oncol. 2001;83(1):72–80.

    Article  CAS  Google Scholar 

  64. Everett E, Tamimi H, Greer B, et al. The effect of body mass index on clinical/pathologic features, surgical morbidity, and outcome in patients with endometrial cancer. Gynecol Oncol. 2003;90(1):150–7.

    Article  CAS  Google Scholar 

  65. Wright JD, Powell MA, Herzog TJ, et al. Panniculectomy: improving lymph node yield in morbidly obese patients with endometrial neoplasms. Gynecol Oncol. 2004;94(2):436–41.

    Article  Google Scholar 

  66. Scribner Jr DR, Walker JL, Johnson GA, McMeekin DS, Gold MA, Mannel RS. Laparoscopic pelvic and paraaortic lymph node dissection in the obese. Gynecol Oncol. 2002;84(3):426–30.

    Article  Google Scholar 

  67. Obermair A, Manolitsas TP, Leung Y, Hammond IG, McCartney AJ. Total laparoscopic hysterectomy versus total abdominal hysterectomy for obese women with endometrial cancer. Int J Gynecol Cancer. 2005;15(2):319–24.

    Article  CAS  Google Scholar 

  68. Kohler C, Klemm P, Schau A, et al. Introduction of transperitoneal lymphadenectomy in a gynecologic center: analysis of 650 laparoscopic pelvic and paraaortic transperitoneal lymphadenectomies. Gynecol Oncol. 2004;95(1):52–61.

    Article  Google Scholar 

  69. Gehrig PA, Cantrell LA, Shafer A, Abaid LN, Mendivil A, Boggess JF. What is the optimal minimally invasive surgical procedure for endometrial cancer staging in the obese and morbidly obese woman? Gynecol Oncol. 2008;111:41–5.

    Article  Google Scholar 

  70. Seamon LG, Bryant SA, Rheaume PS, Kimball KJ, Huh WK, Fowler JM, Phillips GS, Cohn DE. Comprehensive surgical staging for endometrial cancer in obese patients. Obstet Gynecol. 2009;114:16–21.

    Article  Google Scholar 

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Sonoda, Y., Monemvasitis, G. (2015). Early-Stage Endometrial Cancer: Surgery. In: Muggia, F., Santin, A.D., Oliva, E. (eds) Uterine Cancer. Current Clinical Oncology. Springer, Cham. https://doi.org/10.1007/7631_2015_9

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  • DOI: https://doi.org/10.1007/7631_2015_9

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-47267-6

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