Objective. The purpose of this project was to prospectively evaluate the fe
asibility of an alternative technique for surgically staging patients with
endometrial cancer.
Methods. Patients with endometrial cancer were enrolled in this protocol fr
om September 1999 until August 2000. The staging procedure included pelvic
washings via colpotomy, total vaginal hysterectomy, bilateral salpingo-ooph
orectomy (TVH/BSO), and extraperitoneal pelvic and paraaortic lymphadenecto
my (EP-LND) if indicated. Tumor characteristics, time and feasibility of su
rgical procedures, length of hospital stays, and complications were prospec
tively recorded.
Results. Twenty-one patients were enrolled. Grade 1, 2, and 3 tumors were i
dentified in 6 (29%), 10 (48%), and 5 (24%) patients, respectively. Pelvic
washings and TVH/BSOs were performed on all patients. A total of 21/21 (100
%) uterine specimens were removed vaginally and 41/42 (98%) adnexa were res
ected vaginally. EP-LNDs were performed on 17 (81%) patients due to patholo
gic findings of the uterine specimens. The median time to perform a TVH/BSO
was 68 (47-149) min. The median time to complete a EP-LND was 77 (59-107)
min. The median number of postoperative days was 1 (1-5). Complications wer
e infrequent and mild.
Conclusions. TVH/BSO, pelvic washings, and EP-LND is a feasible alternative
to standard surgical staging of endometrial cancer. The minimal amount of
exposure to the intraperitoneal space makes this approach arguably the leas
t invasive for endometrial cancer staging and accounts for the decrease in
recovery time and shortened hospital stays. The acceptable length of surgic
al time, short hospital stays, and minimal requirements for surgical instru
ments make this approach potentially the most cost-effective option for sur
gically staging patients with endometrial cancer. A randomized trial compar
ing this technique to standard surgical staging is warranted, (C) 2001 Acad
emic Press.