STAGING LAPAROTOMY FOR ENDOMETRIAL CARCINOMA - ASSESSMENT OF PERITONEAL SPREAD

To evaluate surgical staging procedures in women with endometrial carc inoma, we examined the techniques used to assess the peritoneal cavity in 295 clinical stage I patients treated between 1985 and 1993. These patients were felt to be at increased risk for extrauterine disease b ecause of significant myometrial invasion, high-grade (2 or 3), or var iant histology (papillary serous, clear cell, or mixed). Patients had a mean of two intraperitoneal samples taken: 224 patients (76%) had at least an omental biopsy and peritoneal cytology. Additional peritonea l biopsy sites included pericolic gutters (50), pelvic peritoneum (45) , bowel serosa/mesentery (24), diaphragm (22), appendix (11), and adhe sions (7). At the time of staging laparotomy, 22 patients (7.5%) had g ross evidence of peritoneal spread, which was readily confirmed by dir ected biopsy. In the 273 women without gross peritoneal disease, 3 (1% ) had microscopic metastases in palpably abnormal biopsies, and 22 had positive cytology as the only evidence of peritoneal disease. Only th ree operative complications were potentially attributable to peritonea l assessment: cystotomy (1), partial small bowel obstruction (1), and ileus (1). Peritoneal failures have been noted in 12 patients over a m ean follow-up interval of 39 months. Seven of these patients had obvio us peritoneal disease at laparotomy. Two of the remaining 5 had optima l peritoneal sampling and represent false-negative cases. A staging la parotomy that included total abdominal hysterectomy with adnexal resec tion, cytology, omental biopsy, and biopsy of grossly abnormal sites w ould have potentially identified all patients with known peritoneal di sease. Routine biopsy of other grossly normal peritoneal sites is asso ciated with extremely low yield and is not recommended. (C) 1995 Acade mic Press, Inc.