CHAPTER 13

Endometrial Carcinoma With Lymph Node Sampling

Endometrial cancer is the most common gynecologic malignancy in the United States. Since 1988, endometrial cancer has been regarded by the International Federation of Gynecology and Obstetrics (FIGO) as a surgically staged disease. Despite this, at present only a minority of women with endometrial cancer undergo formal surgical staging. The considerable heterogeneity in surgical care for women with endometrial cancer is due to multiple factors: limited access to gynecologic oncologists in some regions, a generally favorable prognosis—particularly with histologic grade 1 disease (Fig. 13–1), and fundamental disagreement regarding the role of pelvic and aortic lymphadenectomy in women with endometrial cancer.

A full staging procedure for most endometrial cancer consists of a total (extrafascial) hysterectomy with bilateral salpingo-oophorectomy, as well as pelvic and aortic lymphadenectomy and pelvic washings. In available literature, oncologic outcomes are similar for open, laparoscopic, and robotic approaches; the route of the procedure therefore may be individualized to the needs of each patient and surgeon. In some select cases of endometrial cancer that is preoperatively identified to be metastatic to the cervix (stage II), a radical hysterectomy may be chosen by the surgeon. Although the role of surgical cytoreduction is not as well established for endometrial cancer as it is for ovarian cancer, data suggest a survival benefit in cases of metastatic disease when optimal cytoreduction is achieved.

For a pelvic lymphadenectomy (Figs. 13–2 to 13–4

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