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EP466 Stage II/III endometrial cancer - how RADICAL should we be? A review of management in the northern ireland regional cancer centre
  1. S Addley,
  2. M McComiskey,
  3. S Dobbs,
  4. H Nagar,
  5. E Craig and
  6. I Harley
  1. Gynae Oncology, Belfast City Hospital, Belfast, UK

Abstract

Introduction/Background ESGO guidance (2016) recommends simple hysterectomy and lymphadenectomy (PLN/PALN) for stage II and III endometrial cancer. BGCS guidance (2017) also recommends simple hysterectomy in both stage II/III disease, but advises reserving lymph node dissection for stage III only.

Methodology Practice in the Northern Ireland Regional Cancer Centre was compared with current ESGO and BGCS guidance. A retrospective case-note review was performed for patients undergoing surgery for stage II/III endometrial cancer in the NI Regional Cancer Centre between 2013 and 2018.

Results 53 cases were identified, with mean age 60.5 years and mean BMI 30.6 kg/m2. 62% of the cohort had stage II endometrial cancer on pre-operative MRI; and 38% stage III.

50% of surgeries were performed by Consultants ‘buddy-operating’. All patients underwent radical hysterectomy - 84% laparoscopically, with a conversion to open rate of 6.9%. 96% had concomitant BSO; 94% PLND and 23% PALND. PALND was performed in 25% with pre-operative stage III disease. One case of bowel injury occurred intra-operatively.

Histopathology reported parametrial involvement in 19% of pre-operative stage II and 25% of pre-operative stage III cases. Histopathology also identified positive PLN in 19% and 25% of pre-operative stage II and III cases respectively; and positive PALN in 3.8% and 6.3% of these cases.

Post-operatively, 7% of patients required HDU. The mean haemoglobin drop was 15 g/dl. Urinary retention was the most common complication (19%). Mean length of stay was 4.9 days.

Conclusion In accordance with current guidance and in light of the higher morbidity associated with a radical approach, a change of practice to simple hysterectomy has been recommended within the unit. The role of lymphadenectomy remains controversial, particularly in stage II disease; a population which may particularly benefit from the introduction of sentinel lymph node sampling in the future.

Disclosure Nothing to disclose.

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