Surgery for Uterus/Endometrium

Early Stage Endometrial Cancer

Definition

Tumour confined to pelvic area

Approach: Preferred is key hole surgery(laparoscopy/robotic)

 

A.      Low risk

 

B.      High risk

 

TAH + BSO/Radical Hysterectomy if required

 

Low risk

PLUS formal pelvic node dissection

Washings

 

Consider upper abdominal staging (clear cell and papillary serous)

 

?node sampling

 

Consider radical hysterectomy (cervix)

 

 Late stage Endometrial Cancer

Definition:

Tumour (probably) not confined to pelvic area / uterus and adnexae

AIM:

Tumour debulking as for ovarian cancer

Maximum information for logical adjuvant treatment

 

Pelvic clearance:

~always possible

Includes removal of pelvic nodes – normal and involved

Upper abdominal staging / debulking:

Omentum

Visible disease

Para-aortic nodes

 Surgery Not  indicated for:

Advanced Parametrial (paracervical) disease

Metastatic disease (outside abdomen )