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Abstract
Introduction/Background Current guidelines exclude omentectomy from staging for endometrioid adenocarcinoma, although final histological subtype may change. We assessed the incidence of omental involvement in different histological subtypes of high-grade endometrial carcinoma and the effect of omentectomy on survival in these groups.
Methodology All women surgically staged for high-grade endometrioid or non-endometrioid adenocarcinoma between 2002–2022 were included; their pathological samples were reviewed and clinical data was collected from patients’ records. Characteristics and outcomes of women who did vs. did not undergo omentectomy were compared stratified by histological subtype. Kaplan Meyer survival curves compared overall survival (OS) and progression-free survival (PFS).
Results 251 cases were included, 149 (59.4%) underwent omentectomy of these 34 (22.8%) were high-grade endometrioid and 115 (77.2%) were non-endometrioid subtype. Overall incidence of omental involvement was 12.1% (18 cases –2 high-grade endometrioid). 20 cases (8%) were reclassified to a different histologic subtype following completion of staging. No significant differences were noted between the groups regarding demographic or clinical characteristics. Overall survival (OS) and progression-free survival (PFS) were not significantly different between study groups (11.4 vs. 11.0 years, p=0.4 and 5.0 vs. 4.5 years, p=0.8 respectively). Kaplan Meyer survival curves demonstrated decreased OS for those who underwent omentectomy (log rank test = 0.0026) with no effect on PFS (log rank test p=0.33). OS and PFS were significantly reduced for the non-endometrioid group who did not undergo omentectomy (8.9 vs. 11.2 years, p=0.04 and 2.2 vs. 4.6 years, p=0.04 respectively). Multivariate analysis for high-grade endometrioid carcinoma demonstrated that omentectomy in this population has no significant effect on OS (aHR 2.28 95%CI 0.99–5.23) or PFS (aHR 1.45 95%CI 0.77–2.75), controlling for age, stage, LVSI and lymph node involvement.
Conclusion The current study shows no survival advantage in performing an omentectomy in patients diagnosed with high-grade endometrioid type endometrial cancer and corroborate with current guidelines.
Disclosures The authors have nothing to disclose.
