Surgical staging of low-risk Stage IA endometrioid endometrial cancers

Surgical staging in early endometrial cancer is not universally done and lymphadenectomy in early-stage disease is controversial. Aim of the present study was to evaluate surgical staging in patients with endometrioid histology, FIGO Stage IA endometrial cancer.

Eighty-seven patients with FIGO Stage IA, low-risk patients were included in the study. Staging surgery group included patients who had comprehensive surgical staging (hysterectomy, oophorectomy, and pelvic lymph node dissection with or without para-aortic lymph node dissection). Non-staging surgery group included patients who had hysterectomy, and bilateral oophorectomy with or without lymph node sampling. Two groups were compared for lymph node status, occult cervical involvement, other prognostic factors, and outcome were analyzed.

In total 17.2% of patients were upstaged in final pathological examination; 12.9% in non-staging surgery group and 24.2% in staging surgery group. Upstaging was due to lymph node involvement (6%), cervical stromal invasion (13.7%), and myometrial invasion greater than 50% (1.1%). Median pelvic lymph node number was 23 and pelvic lymph node metastases was found in 3% of the patients. Median para-aortic lymph node number was 11.5 and there was one isolated para-aortic lymph node metastases (5.8%).

Of the patients, 17.2% had stage migration. Until the issue is solved by future studies, surgical staging might be considered standard surgery for endometrial cancer.