[Differentiated operative therapy of endometrial carcinomas]

The traditional surgical procedure to treat operable endometrial cancer is the removal of the uterus and both adnexa. In the trend of modern gynecological oncology this standardized operation should be changed in favour to a more individual procedure adapted to preoperative and intraoperative stage of the disease. A carefully fractioned curettage (of the cervix and the corpus uteri) is necessary to differ stage I (T1) and stage II (T2). Further important prognostic factors as myometrial invasion, nodal status, lymph vessel and blood vessel involvement and the intraabdominal findings (T3) are details of the post-surgical evaluation. A differentiated surgical treatment of the endometrial cancer includes for a stage I disease hysterectomy, bilateral adnectomy and pelvine lymphonodectomy. We recommend this additional procedure in all stages of the disease: The nodal status is for almost all genital cancers and breast cancer the most important prognostic factor. Postoperative adjuvent therapy (radiotherapy, hormonal therapy, chemotherapy) may be indicated by that. The surgical procedure for stage II (corpus and cervix involved) disease is a radical hysterectomy (Wertheim), bilateral adnectomy and pelvine lymphonodectomy. A paraaortal lymphonodectomy may be recommended, but most of the patients are 70 years and more and have a multimorbidity. Therefore, we indicated this additional procedure only in 7.5% of the operated patients. The surgical strategy in the (rare) stage III individual cancer is similar to the procedure in progressive ovarian cancer: Cytoreduction and debulking (e.g. omentum majus, peritoneum, involved bowel) has to be performed subsequent to hysterectomy, bilateral adnectomy and lymphonodectomy to improve the poor prognosis.