title: Outcomes of patients with low-risk endometrial cancer surgically staged without lymphadenectomy based on intra-operative evaluation.
abstract: OBJECTIVE
  The objective of the study was to evaluate clinical outcomes in patients with stage I endometrial cancer undergoing surgical management without lymphadenectomy based on intra-operative assessment for low-risk disease.
  
  
  METHODS
  Between 2000 and 2009, a total of 179 patients were surgically staged without lymphadenectomy for low-risk stage I endometrial cancer. Low-risk cancer was defined by intra-operative criteria based on both gross and frozen tissue microscopic evaluation: 1) G1 or G2 endometrioid histology; 2) myoinvasion <50%; 3) no cervical disease, and 4) no intra-abdominal metastasis. Records were reviewed for postoperative complications, pathological diagnoses, adjuvant radiation treatment, cancer recurrence, and mortality.
  
  
  RESULTS
  Morbidity, cancer recurrence, and disease-specific mortality were low. Postoperative complications occurred in 5 patients (2.8%). Nine patients (5.0%) were offered adjuvant radiation for higher risk disease diagnosed on final pathology. Radiation morbidity was minimal: grade 1 vaginal toxicity in 2 patients. Three patients (1.7%) experienced recurrent cancer with mean time to recurrence of 43.7 months. Five year overall survival was 95.8%. The five year probability of disease-specific death was 1.1%.
  
  
  CONCLUSIONS
  In an institution with reliable capability of pathological frozen tissue diagnosis, omission of lymph node dissection is a reasonable option in the surgical management of those patients with low-risk disease diagnosed by intra-operative factors.
authors.affiliation: Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States. Electronic address: jeff.bell@ohiohealth.com.
authors.forename: Jeffrey G
authors.initials: JG
authors.lastname: Bell
authors.affiliation: Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States.
authors.forename: Diana M
authors.initials: DM
authors.lastname: Patterson
authors.affiliation: OhioHealth Reseach Institute, 3545 Olentangy River Road, Columbus, OH 43214, United States.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Klima
authors.affiliation: Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States.
authors.forename: Michelle
authors.initials: M
authors.lastname: Harvison
authors.affiliation: Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States.
authors.forename: Kellie
authors.initials: K
authors.lastname: Rath
authors.affiliation: Riverside Methodist Hospital, 3535 Olentangy River Road, Columbus, OH 43214, United States.
authors.forename: Gary
authors.initials: G
authors.lastname: Reid
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D016889:Endometrial Neoplasms / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008197:Lymph Node Excision; D008875:Middle Aged; D009367:Neoplasm Staging; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome
keywords: Cancer; Endometrial; Lymphadenectomy; Outcomes; Staging; Survival