What is endometrial cancer staging surgery? What does it do?

Author: Wu Ming, Chief Physician, Peking Union Medical College Hospital

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

Endometrial cancer is mainly manifested by irregular vaginal bleeding and discharge. Postmenopausal women who experience vaginal bleeding and discharge, and premenopausal women who experience non-menstrual vaginal bleeding and discharge, increased menstrual flow, and prolonged menstrual periods should seek medical attention in a timely manner.

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Most early-stage endometrial cancers are staged mainly by surgical pathology. A small number of patients are found to have distant metastases, such as lung metastases and multiple metastases to abdominal organs, through imaging examinations when they visit the doctor, indicating that the disease is already in the late stage. In this case, staging surgery is not necessary because it is difficult to benefit from surgery.

Therefore, for endometrial cancer, imaging examinations should be performed first, and whether or not to perform staging surgery should be decided based on whether or not there is distant metastasis. Some cases have intra-abdominal metastasis but no thoracic metastasis, and it is possible to completely remove the tumor through surgery, and staging surgery can also be performed.

1. Which tissues or organs should be removed during staging surgery for endometrial cancer?

The staging surgery for endometrial cancer requires total extrafascial hysterectomy and bilateral adnexectomy (fallopian tube and ovary); pelvic lymph node dissection and para-aortic lymph node dissection, and the para-aortic lymph node dissection should preferably be cut to the level of the renal vessels; pelvic and abdominal lavage and cytological examination are also required.

After surgery for endometrial cancer, the postoperative pathology and various examination results are combined to determine whether the surrounding tissues have been invaded by the tumor. Staging is performed according to international unified standards, and based on the staging, it is determined whether adjuvant radiotherapy and chemotherapy are needed after surgery to reduce recurrence and increase survival.

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Endometrial cancer has been evaluated preoperatively and there is no clear distant metastasis or abdominal metastasis, and there are no contraindications to laparoscopic surgery. Generally, endometrial cancer staging surgery can be performed under laparoscopy. Laparoscopic surgery has very small incisions, less bleeding, and quick recovery. If abdominal metastasis has already occurred, laparoscopy is not a particularly good choice at this time. Sometimes it is difficult to completely remove the tumor through laparoscopy, and this situation generally requires laparotomy.

2. Is the survival rate high after comprehensive staging surgery for endometrial cancer?

After comprehensive staging surgery, no high-risk factors are found for endometrial cancer. The tumor is confined to the uterus, there is no deep myometrial infiltration, and the tumor is well differentiated. It is usually considered to be low-risk endometrial cancer. The risk of treatment failure or death in low-risk endometrial cancer generally does not exceed 5%.

After staging surgery for the earliest stage of endometrial cancer, the five-year survival rate can reach over 90%. If there is no recurrence for five years, the chance of recurrence is very small, which can be regarded as a cure.

The stage is very important for prognosis. Stage I is definitely better than stage II, and stage II is definitely better than stage III. It is relatively difficult to treat stage IV, and at least half of the patients cannot be cured.

3. What are the high-risk factors for endometrial cancer?

The most important high-risk factor for endometrial cancer is the histological type, which can be specifically classified by postoperative pathology.

Another very important high-risk factor that determines the prognosis is the differentiation type of the tumor, whether it is highly differentiated, moderately differentiated, or poorly differentiated. The lower the differentiation, the easier it is to spread outward, the easier it is to infiltrate the muscle layer, and the easier it is to metastasize through the lymph nodes and blood.

Early-stage endometrial cancer, such as stage I and II, combined with high-risk factors, such as poor differentiation type and tissue type, usually requires adjuvant radiotherapy after surgery to reduce the risk of recurrence. If lymph node metastasis, extrauterine infiltration, and metastasis occur, chemotherapy is usually the first choice after surgery, and radiotherapy is the second choice, which can significantly improve the prognosis and increase the chance of survival.

For staging surgery of endometrial cancer, follow-up examinations are generally performed every 3 months in the first year after surgery, every 4 months in the second and third years, every 6 months after three years, and once a year after five years. Follow-up is required throughout life.

The most common site of metastasis for recurrent endometrial cancer is the lungs, followed by the liver, so the most important follow-up examinations are chest X-rays and B-ultrasounds of the liver, gallbladder, pancreas, spleen, and kidneys. In addition, pelvic examinations and tumor marker tests are also required.