title: Distribution and volume of extrauterine disease in uterine serous carcinoma: is minimally invasive surgery a suitable approach?
abstract: OBJECTIVE
  Minimally invasive surgery (MIS) is the preferred technique for managing endometrial cancer. Given that uterine serous carcinoma (USC) has a predilection for multiquadrant peritoneal dissemination, our objective was to estimate the potential risk for overlooking occult peritoneal spread with the use of MIS.
  
  
  METHODS
  A single-institution, retrospective review was conducted of patients who underwent primary surgical staging for endometrial cancer via laparotomy between 1999 and 2008. Patterns of metastases were analyzed to estimate the potential risk for understaging via MIS.
  
  
  RESULTS
  A total of 202 USC cases met inclusion criteria. Pelvic and para-aortic nodes were positive in 59 (36%) of 166 and 43 (31%) of 138, respectively. Stage IVb disease was diagnosed in 77 (38%) of 202 patients. The majority (86%, 66/77) harbored bulky and/or multisite macroscopic abdominal implants. Isolated microscopic peritoneal disease was present in 5 of 77 cases (6% of stage IV, 2% of the entire cohort) but, in all cases, was limited to the omentum; 6 of 77 cases (8% of stage IV, 3% of the cohort) harbored a single implant in the context of a negative omentum but, in all cases, were macroscopic (locations included the ileum, the diaphragm, and the base of the mesentery).
  
  
  CONCLUSIONS
  For providers who aim to remove all visible disease in patients with USC, the rate of extrauterine disease escaping detection using MIS is low (<3%) provided an omentectomy is performed together with staging.
authors.affiliation: Divisions of *Gynecologic Surgery, †Biomedical Statistics and Informatics, and ‡Anatomic Pathology, Mayo Clinic, Rochester, MN.
authors.forename: Tina A
authors.initials: TA
authors.lastname: Ayeni
authors.forename: Mariam M
authors.initials: MM
authors.lastname: AlHilli
authors.forename: Jamie N
authors.initials: JN
authors.lastname: Bakkum-Gamez
authors.forename: Andrea
authors.initials: A
authors.lastname: Mariani
authors.forename: Michaela E
authors.initials: ME
authors.lastname: McGree
authors.forename: Amy L
authors.initials: AL
authors.lastname: Weaver
authors.forename: William A
authors.initials: WA
authors.lastname: Cliby
authors.forename: Gary L
authors.initials: GL
authors.lastname: Keeney
authors.forename: Karl C
authors.initials: KC
authors.lastname: Podratz
authors.forename: Sean C
authors.initials: SC
authors.lastname: Dowdy
mesh_terms: D000368:Aged; D018284:Cystadenocarcinoma, Serous / Q000556:secondary* / Q000601:surgery; D016889:Endometrial Neoplasms / Q000556:secondary* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy; D008207:Lymphatic Metastasis; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000473:pathology* / Q000601:surgery; D009367:Neoplasm Staging; D010220:Para-Aortic Bodies / Q000473:pathology*; D010386:Pelvic Neoplasms / Q000556:secondary* / Q000601:surgery; D011379:Prognosis; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000473:pathology* / Q000601:surgery