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LiFE re

Literature for ENYGO

Surgical treatment of primary uterine cancer

Editor Piotr Lepka E C in elderly women. Rauh-Hain et al. retrospectively analysed
2,468 patients with grade 3 adenocarcinomas, carcinosarcomas,
Descriptive summary clear-cell carcinomas and uterine serous carcinomas. They demon-
strated that patients ≤ 55 years were more likely to undergo
In the period covered by the third LiFE report, the -ESMO-ESTRO-ES- surgery (and lymph node dissection) than women >75 years.
GO recommendations and consensus on endometrial cancer (EC) Older women were also less likely to be treated with chemo- and
treatment were published. Regarding the surgical treatment of EC, radiotherapy.
the main recommendations are:
R isk of nodal metastasis. Jorge et al. demonstrated in their
P eritoneal cytology is no longer considered mandatory for staging. retrospective analysis that lymphovascular space invasion (LVSI)
is an independent predictor of lymph node metastases for women
If a lymphadenectomy is performed, systematic removal of pelvic with <50 % myoinvasion. Regardless of the depth of invasion and
and para-aortic nodes up to the level of the renal veins should be tumour grade, LVSI was also an independent predictor of survival.
considered.
A denomyosis and EC. Gizzo et al. suggested that the intraopera-
L ymphadenectomy is a staging procedure and allows tailoring tive evaluation of the presence of adenomyosis in patients with
of adjuvant therapy (for patients with a low risk of lymph node EC (associated with lower grades in FIGO stage, myometrial inva-
involvement, it is not recommended; for intermediate risk, it can sion, lymphovascular space involvement, lymph node involvement,
be considered for staging purposes; in the high-risk group, it is and tumour size) may aid surgeons in estimating oncological risk
recommended). and tailoring surgical treatment.

L ymphadenectomy to complete staging could be considered in
previously incompletely operated high-risk patients.

R adical hysterectomy is not recommended for the management
of stage II EC; surgery should be tailored in order to obtain free
margins. Lymphadenectomy is recommended for clinical or
intra-operative stage II.

C omplete macroscopic cytoreduction and comprehensive staging
is recommended in advanced endometrial cancer and multimodali-
ty therapy is required.

In non-endometrioid endometrial cancer (apparent stage I) lym-
phadenectomy is recommended.

S taging omentectomy is not mandatory in clear cell or undifferen-
tiated endometrial carcinoma and carcinosarcoma but should be
considered in serous carcinoma.

Other issues discussed in the available literature were:

P reoperative evaluation. Su et al. retrospectively evaluated the ac-
curacy of preoperative hysteroscopic biopsy compared to dilation
and curettage (D&C) in patients with EC. The authors concluded
that hysteroscopic biopsy could provide more precise information
on histological grade of differentiation, compared to D&C. Knowl-
edge of the correct grade would allow for a more accurate staging
plan, based on the preoperative risk evaluation.

Continued on the next page  Page 26

International Journal of Gynecological Cancer, Volume 26, Supplement #1