2017 Volume 33 Issue 1 Pages 63-68
Objective: According to the Treatment Guidelines for Uterine Body Cancer by the Japan Society of Gynecologic Oncology, pelvic lymphadenectomy can be omitted in patients with endometrial adenocarcinoma G1 or G2, ≤1/2 myometrial invasion, and no findings of extrauterine lesion. We aimed to identify indications for omitting pelvic lymphadenectomy in selected cases by reviewing cases of total laparoscopic hysterectomy (TLH) for early-stage endometrial cancer retrospectively.
Methods: The study subjects were 17 patients with atypical endometrial hyperplasia complex (AEHC) or stage IA endometrial cancer (endometrial adenocarcinoma G1/G2) who underwent TLH in our department between April 2013 and March 2015. We compared preoperative histopathological diagnosis and imaging findings with postoperative histopathological diagnosis.
Result(s): Twelve patients (AEHC, n = 6 and endometrial cancer, n = 6) had no myometrial invasion and 5 (AEHC, n = 1 and endometrial cancer, n = 4) had ≤1 or 2 myometrial invasions on preoperative magnetic resonance imaging. In the postoperative histopathological study of the patients with endometrial cancer, none of the patients had a myometrial invasion before surgery, 1 patient had no myometrial invasion, 2 had <1 or 2 myometrial invasion, and 3 had ≥1 or 2 myometrial invasion. In the comparison between the preoperative and postoperative histology, 4 cases of AEHC and 3 cases of stage IA endometrial cancer showed progression. Five patients received postoperative adjuvant therapy, and 2 patients had a recurrence.
Conclusion(s): Pelvic lymphadenectomy in patients with a low risk of recurrence could be omitted. However, some cases showed progression based on postoperative histology. Thus, further study about the indication for omitting lymphadenectomy seems necessary.
