The Role of Modified Radical Hysterectomy in Endometrial Carcinoma

Improvement of the treatment results in patients with endometrial carcinoma has been achieved by a multidisciplinary approach including surgery, chemotherapy and radiotherapy, similar to the case for many other carcinomas. Although total hysterectomy/bilateral salpingo-oophorectomy (TH/BSO), pelvic and para-aortic lymphadenectomy and peritoneal cytology are often required, cases with early carcinomas predominate among cases of endometrial carcinoma, and TH/BSO alone is sufficient to achieve a favorable prognosis in such cases. The recommended surgical procedure for the staging of a patient with endometrial carcinoma clinically confined to the fundal portion of the uterus includes peritoneal cytology and TH/BSO with pelvic and para-aortic lymphadenectomy (National Comprehensive Cancer Network, 2011). For operable patients with cervical involvement, peritoneal cytology and radical hysterectomy/bilateral salpingooophorectomy with pelvic and para-aortic lymphadenectomy should be considered. However, radical hysterectomy always has a major adverse effect with dysuria. Improvement of the treatment results and quality of life (QOL) can also be expected from modified radical hysterectomy performed in appropriately selected patients. One of the advantages of modified radical hysterectomy is that it can be switched from radical hysterectomy in high-risk patients in terms of the age, obesity and presence of medical complications. For operable patients with intra-abdominal disease, surgical procedure includes peritoneal cytology, TH/BSO with pelvic and para-aortic lymphadenectomy, and maximal debulking. The pathologic information obtained also provides an optimal basis for the selection of adjuvant therapy. Therefore, complete surgical staging including pathologic and prognostic data on which to base decisions regarding adjuvant therapy should be required for all patients who do not have medical or technical contraindication to lymphadenectomy.