A vaginal and extraperitoneal approach to surgically stage patients with endometrial cancer

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.