Discussion Questions

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  What novel idea is addressed in this study?

  
  
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  What is the study design?

  
  
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  What statistical tests were applied and why?

  
  
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  What were the key findings of this study

  
  
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  What do you think of the algorithm proposed in Figure 1?

  
  
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  Are there limitations regarding the use of tumor diameter?

  
  
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  What are the strengths and limitations of the study?

Endometrial cancer, a postmenopausal disease often linked to obesity, is the most common gynecologic cancer in the United States. In 2010, 43,000 new cases were diagnosed and 7900 deaths occurred. The majority of endometrioid adenocarcinomas are confined to the uterus, and many patients do not require adjuvant treatment after surgery. However, nonendometrioid adenocarcinomas—papillary serous and clear cell adenocarcinomas—are associated with a worse prognosis and disease progression is unlike that of the more common endometrioid adenocarcinomas.

In the United States, endometrial cancers are staged surgically; this is not the case in many European countries. Yet, the International Federation of Gynecology and Obstetrics (FIGO) issued updated recommendations in 2009 for the staging of endometrial malignancies (and other cancers), and these continue to incorporate prognostic factors found at surgery. Pelvic and periaortic lymph node assessment remain important aspects of staging.

However, surgical staging can be associated with increased surgical morbidity, including injury to vessels, ureters, and nerves and lymphocyst formation. Additionally, because many women who develop endometrial cancer tend to be obese, the task of surgical staging can be technically challenging, although the robotic approach has remedied some of these technical difficulties. Nonetheless, it would be beneficial if recommendations for lymphadenectomy could be further refined to spare some patients the need for lymph node dissection.

While some institutions perform surgical staging for all patients with endometrial cancer, others may use frozen section to decide who should undergo lymphadenectomy as part of their surgical staging. Parameters such as the histologic grade or depth of tumor invasion found on frozen section have been used in numerous algorithms to determine which patients should go on to lymphadenectomy.