Introduction/Background Type 2 endometrial cancer includes aggressive histologic subtypes such as serous, clear cell and carcinosarcoma of the endometrium. These tumors have a propensity for intra-abdominal spread, a high recurrence rate, and a poor prognosis. When extra-uterine disease is present, surgical debulking is attempted when possible. The aim of this study was to determine whether resection of normal appearing omentum influences survival.
Methodology We retrospectively identified cases with type 2 endometrial cancer at our Gynecologic Oncology Division from 1998 to 2017. Medical records were reviewed for the following information: age at diagnosis, preoperative imaging, operative findings, surgical procedure, final histology with definitive International Federation of Gynecology and Obstetrics stage, adjuvant treatment and survival.
Results A total of 90 patients with type 2 endometrial cancer were identified, of whom 79 had primary operation. All women underwent at least hysterectomy with bilateral salpingo-oophorectomy. Seventeen women (21.5%) were found to have macroscopic extrauterine disease, hence omentectomy was part of the operation and these patients were excluded from evaluation. The final study group included 62 women with no macroscopic evidence of omental metastasis. 36 underwent omentectomy and had no histologic evidence of spread (group 1) compared to 26 women that did not undergo omentectomy (group 2). By multivariate analysis, survival was significantly influenced by stage, deep stromal invasion and lymph-vascular space involvement. However, when only stage I patients (n=32) were compared, the median survival of women who did not have omentectomy was 7.8±0.4 years while the median survival of the women who underwent omentectomy was not yet reached.
Conclusion It appears that the resection of normal appearing omentum later found to have no metastases improves survival in patients with stage I type 2 aggressive endometrial cancer.
Disclosure Nothing to disclose.
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