title: Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis.
abstract: BACKGROUND
  A patient with early-stage endometrial cancer may possibly have microscopic metastasis in the omentum, which is associated with a poor prognosis. The purpose of this study was to identify risk factors for microscopic omental metastasis in patients with clinical stage I endometrial cancer to establish the indications for selective omentectomy.
  
  
  METHODS
  We searched the PubMed, EMBASE, and Cochrane Library databases for published studies from inception to August 2014, using terms such as 'endometrial cancer' or 'uterine cancer' for disease, 'omentectomy' or 'omental biopsy' for intervention, and 'metastasis' for outcome. Two reviewers independently identified the studies that matched the selection criteria. We calculated the pooled risk ratios (RRs) with 95 % confidence intervals (CI) of each surgicopathologic finding for microscopic omental metastases in clinical stage I endometrial cancer. We also calculated the prevalence of microscopic omental metastases.
  
  
  RESULTS
  Among 1163 patients from ten studies, 22 cases (1.9 %) of microscopic omental metastases were found, which accounted for 26.5 % of all omental metastases. Positive lymph nodes (RR 8.71, 95 % CI 1.38-54.95), adnexal metastases (RR 16.76, 95 % CI 2.60-107.97), and appendiceal implants (RR 161.67, 95 % CI 5.16-5061.03) were highly associated with microscopic omental metastases.
  
  
  CONCLUSIONS
  Microscopic omental metastases were not negligible in patients with clinical stage I endometrial cancer. Those with a risk factor of microscopic omental metastases were recommended for selective omentectomy.
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.|Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea.
authors.forename: Won Duk
authors.initials: WD
authors.lastname: Joo
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Schwartz
authors.affiliation: Department of Obstetrics, Gynecology and Reproductive Sciences, Yale University School of Medicine, New Haven, CT, USA.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Rutherford
authors.affiliation: Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea. seong.seokju@gmail.com.
authors.forename: Seok Ju
authors.initials: SJ
authors.lastname: Seong
authors.affiliation: College of Literature, Science, and the Arts, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Junbeom
authors.initials: J
authors.lastname: Ku
authors.affiliation: Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea.
authors.forename: Hyun
authors.initials: H
authors.lastname: Park
authors.affiliation: Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea.
authors.forename: Sang Geun
authors.initials: SG
authors.lastname: Jung
authors.affiliation: Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea.
authors.forename: Min Chul
authors.initials: MC
authors.lastname: Choi
authors.affiliation: Department of Obstetrics and Gynecology, CHA University School of Medicine, Seongnam, Republic of Korea.
authors.forename: Chan
authors.initials: C
authors.lastname: Lee
mesh_terms: D001063:Appendiceal Neoplasms / Q000556:secondary*; D016889:Endometrial Neoplasms / Q000473:pathology*; D005185:Fallopian Tube Neoplasms / Q000556:secondary*; D005260:Female; D006801:Humans; D008207:Lymphatic Metastasis; D061206:Neoplasm Micrometastasis / Q000473:pathology*; D009367:Neoplasm Staging; D009852:Omentum / Q000473:pathology* / Q000601:surgery; D010051:Ovarian Neoplasms / Q000556:secondary*; D012307:Risk Factors