Surgical treatment of endometrial cancer at a Teaching Hospital in the United States

Objective: To evaluate the attitude of primary care gynecologists to histop athologic staging of endometrial cancer and the impact of lymphadenectomy o n long-term survival. Methods: We reviewed the hospital records of 50 patients operated on by 26 attending physicians at an academic teaching hospital in the United States between 1990 and 1995. We compared data of surgeons performing < 3 procedur es with those of surgeons performing greater than or equal to 3 operations. Data were compared with the chi-square test and Kaplan-Meier analysis. Results: Thirty-five patients (70 %) were > 61 years old. Lymphadenectomy w as performed in 21 of 48 patients (44 %). Lymphadenectomy was performed in 15 of 39 patients with stage I endometrioid disease, all four patients with more advanced stage disease, and two of five patients with serous papillar y or clear cell carcinoma (40 %). Two extirpated uteri were free of maligna ncy. The histologic grade of the tumor and myometrial invasion were the mos t important factors influencing the decision for lymphadenectomy. Surgeons with greater than or equal to 3 procedures tended to perform lymphadenectom y more frequently than those performing fewer operations. Kaplan-Meier anal ysis showed no survival advantage for patients undergoing lymphadenectomy. Conclusions: Surgical experience seems to influence the surgical approach t o endometrial cancer.