5 things to know about endometrial cancer surgery!

Author: Zhang Jingfei, deputy chief physician, Beijing Century Altar Hospital, Capital Medical University

Zhao ZheAttending physician at Beijing Century Altar Hospital, Capital Medical University

Reviewer: Bai Wenpei, Chief Physician, Beijing Century Altar Hospital, Capital Medical University

Surgery is a common method for treating tumors, and endometrial cancer is no exception.

For endometrial cancer, the standard surgical method is endometrial cancer staging surgery, which is a comprehensive procedure that usually includes total hysterectomy and removal of bilateral adnexa (i.e. ovaries and fallopian tubes). For cases with high-risk factors, pelvic lymph node resection, para-aortic lymph node resection or greater omentum resection will be performed in order to more accurately assess the condition and formulate subsequent treatment plans. Of course, the specific surgical method needs to be individualized according to the patient's age, disease stage and overall health status.

But overall, surgery is the main treatment for endometrial cancer.

①What preparations do patients with endometrial cancer need to make before surgery?

First, be mentally prepared to accept surgery as a treatment method. Patients and their families should fully communicate with the doctor to understand the condition, what the surgery will be like, what complications may occur during and after the surgery, and what precautions are required.

Second, vaginal preparation is necessary to reduce the risk of infection.

Third, the intestines must be prepared. Eat a residue-free diet 1-3 days before surgery, and take laxatives to empty the intestines in the afternoon of the day before surgery. Ensure complete cleansing, which is beneficial for postoperative defecation, gas discharge, and recovery. In addition, if the intestines are found to be invaded by tumors during surgery and the intestinal tract needs to be removed, the surgery can be completed at the same time. For early-stage patients, considering that intestinal surgery is not involved, the concept of accelerated recovery surgery can be used for preoperative preparation.

Fourth, routine preoperative preparations such as blood preparation should be carried out before the operation.

Fifth, for some patients with advanced disease, distant metastasis, chest and abdominal effusion, chemotherapy should be performed before surgery, which we call neoadjuvant chemotherapy, to shrink the lesions and improve the feasibility of surgery. That is, chemotherapy should be given for two to three courses. When the distant lesions are controlled and the conditions for surgery are met, surgery can be performed. If the conditions for surgery are really not met, radiotherapy and other comprehensive treatments can be added.

②What dietary issues should patients with endometrial cancer pay attention to after surgery?

Generally, you can drink water six hours after the operation after waking up from general anesthesia; twelve hours later, if there is no intestinal damage, you can eat a small amount of liquid food, such as rice soup.

Because this is a relatively large operation, it usually takes 48-72 hours for gastrointestinal function to recover, during which time you may experience discomfort such as abdominal distension. At this time, you should move around properly and turn over frequently to help restore intestinal peristalsis. Exhausting gas is an important sign of gastrointestinal function recovery.

Figure 1 Original copyright image, no permission to reprint

Of course, if there is no gas discharge after surgery, you can use some drugs to promote intestinal motility, such as neostigmine and Simo Decoction, which can promote the recovery of gastrointestinal function.

After the gas is discharged, you can eat semi-liquid food, such as noodles, wontons, egg custard, chicken soup, fish soup, etc. You can also eat some fruits, or drink some milk, etc. After you have a bowel movement, you can resume your normal diet.

③How to prevent the formation of lower limb venous thrombosis in patients with endometrial cancer after surgery?

It is very important to prevent blood clots after surgery.

Endometrial cancer surgery is extensive and takes a long time. There may be a lot of blood loss during the surgery and long-term bed rest after the surgery, which are all high-risk factors for lower extremity venous thrombosis. Older patients are more likely to develop thrombosis.

To prevent thrombosis, patients can wear elastic stockings before and after surgery and receive intermittent pneumatic compression (IPC) therapy. Twenty-four hours after surgery, they must also receive routine anticoagulant therapy to prevent thrombosis.

After lower extremity venous thrombosis occurs, the most serious complication is that the thrombus breaks off and reaches the lungs through the blood circulation, causing pulmonary embolism. This is a fatal disease. Therefore, it is very important to prevent thrombosis.

④What should patients with endometrial cancer do if they suffer from wound pain after surgery?

If it is a laparoscopic surgery, it only has four or five small incisions. Compared with open surgery, the postoperative pain is lighter and the recovery is faster.

If it is an open abdominal surgery, especially a longitudinal incision, because the incision is very long, usually more than ten centimeters, the postoperative wound pain may be quite severe. After the operation, you can use an analgesic pump to relieve the pain, but it cannot achieve a completely painless effect.

Because everyone has a different pain threshold and tolerance, if you still feel severe pain after using the analgesic pump and it affects your rest, you can get another pain injection or take painkillers. In short, reducing pain and ensuring rest will help you get through the important perioperative period of 72 hours after surgery more smoothly.

Figure 2 Original copyright image, no permission to reprint

After the operation, family members should accompany the patient more and give him/her more guidance, so that the patient can adjust his/her mood and keep a good mood. This is also very important for the recovery of the disease.

⑤How to follow up and review patients with endometrial cancer after surgery?

As a malignant tumor, patients with endometrial cancer require lifelong follow-up to monitor the risk of recurrence and distant metastasis.

In the first two years after the end of treatment for endometrial cancer, it is recommended to follow up every 3-6 months to detect early signs of recurrence; during the third to fifth year, it is recommended to follow up every six months; after five years, follow up once a year, and so on. The follow-up interval should be adjusted according to the risk of recurrence.

What should be checked during follow-up? Gynecological examination and pelvic ultrasound are essential, and if necessary, chest, abdominal and pelvic imaging examinations (CT, MRI, and even PET/CT), as well as tumor markers, should be performed. Especially for those suspected of recurrence or metastasis, a careful evaluation should be performed.