title: Implications of a two-step procedure in surgical management of patients with early-stage endometrioid endometrial cancer.
abstract: OBJECTIVE
  Since European Society for Medical Oncology (ESMO) recommendations and French guidelines, pelvic lymphadenectomy should not be systematically performed for women with early-stage endometrioid endometrial cancer (EEC) preoperatively assessed at presumed low- or intermediate-risk. The aim of our study was to evaluate the change of our surgical practices after ESMO recommendations, and to evaluate the rate and morbidity of second surgical procedure in case of understaging after the first surgery.
  
  
  METHODS
  This retrospective single-center study included women with EEC preoperatively assessed at presumed low- or intermediate-risk who had surgery between 2006 and 2013. Two periods were defined the times before and after ESMO recommendations. Demographics characteristics, surgical management, operative morbidity, and rate of understaging were compared. The rate of second surgical procedure required for lymph node resection during the second period and its morbidity were also studied.
  
  
  RESULTS
  Sixty-one and sixty-two patients were operated for EEC preoperatively assessed at presumed low-or intermediate-risk before and after ESMO recommendations, respectively. Although immediate pelvic lymphadenectomy was performed more frequently during the first period than the second period (88.5% vs. 19.4%; p<0.001), the rate of postoperative risk-elevating or upstaging were comparable between the two periods (31.1% vs. 27.4%; p=0.71). Among the patients requiring second surgical procedure during the second period (21.0%), 30.8% did not undergo the second surgery due to their comorbidity or old age. For the patients who underwent second surgical procedure, mean operative time of the second procedure was 246.1±117.8 minutes. Third operation was required in 33.3% of them because of postoperative complications.
  
  
  CONCLUSIONS
  Since ESMO recommendations, second surgical procedure for lymph node resection is often required for women with EEC presumed at low- or intermediate-risk. This reoperation is not always performed due to age/comorbidity of the patients, and presents a significant morbidity.
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France. emmanuelle.arsene@hotmail.fr.
authors: Emmanuelle
authors: E
authors: Arsène
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
authors: Géraldine
authors: G
authors: Bleu
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
authors: Benjamin
authors: B
authors: Merlot
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.
authors: Loïc
authors: L
authors: Boulanger
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France.
authors: Denis
authors: D
authors: Vinatier
authors: Department of Anatomopathology, University Hospital of Lille, Lille, France.
authors: Olivier
authors: O
authors: Kerdraon
authors: Department of Gynecology, Hospital Jeanne de Flandre, University Hospital of Lille, Lille, France.; University of Lille-Nord-de-France, Lille, France.
authors: Pierre
authors: P
authors: Collinet
mesh_terms: D000368:Aged; D018269:Carcinoma, Endometrioid / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007044:Hysterectomy / Q000379:methods / Q000706:statistics & numerical data; D008197:Lymph Node Excision / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging / Q000592:standards; D010388:Pelvis; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D058994:Salpingectomy / Q000379:methods / Q000706:statistics & numerical data
keywords: Complications; Endometrial Neoplasms; Lymph Node Excision; Retrospective Studies; Risk Factors