The incidence of microscopic adnexal metastatic disease in women with presumed early stage endometrial cancer.

Abstract

e17128 Background: The standard surgical staging for endometrial cancer has been established as a total laparoscopic hysterectomy,bilateral salpingo-oopherectomy and lymphadenectomies. However, ovarian removal can have significant consequences in pre- and peri-menopausal women, which comprise 25% newly diagnosed endometrial cancer. The potential ramifications of premature surgical menopause are clinically important. The goal of this study is to determine the incidence of microscopic adnexal metastatic disease in younger patients with presumed early stage endometrial cancer. Methods: From January 2005 through December 2010, 57 women who were 52 years old or younger with presumed early stage endometrial cancer were identified from our institutional database. Inclusion criteria included (1) FIGO grade 1 endometrioid endometrial cancer on endometrial biopsy, or (2) FIGO grade 1 endometrioid endometrial cancer on frozen section specimen with < 50% myometrial invasion, no evidence of metastatic disease on pre-operative imaging, and no grossly visible metastatic disease in the peritoneal cavity during the staging surgery. Results: Of these 57 patients, four (7%) had lymphovascular space invasion, 20 (35%) had lower uterine segment involvement, 26 (45%) had superficial myometrial invasion or no residual carcinoma, while three (5%) unexpectedly had 50% or greater myometrial invasion on final pathology. Half of our patient population (50%) received vaginal brachytherapy. Of the 57 patients, one (1.8%) had microscopic adnexal involvement in a fallopian tube which upstaged her to stage IIIA disease. Pathological risk factors for advanced stage included LVI, lower uterine segment disease, and 50% myometrial invasion. Conclusions: After a thorough pre-operative evaluation and intra-operative exploration, preservation of the ovaries appears to be a safe and viable option for younger women who are diagnosed with presumed early stage disease. We suggest that ovarian preservation should be discussed on an individual basis in pre- peri-menopausal patients who meet the above-mentioned strict eligibility criteria.