Changing the trend of Endometrial Cancer Surgical Treatment and Lymph Node Staging – Results of Oncogynecology Center, Department of Gynecology and Obstetrics, University Hospital Brno and Masaryk University 2012-2021

Abstract

Introduction

In the last decade, the view of endometrial cancer has shifted enormously, and the surgical approach or lymph node staging has changed significantly. We are presenting these changes with the University Hospital Brno Oncogynecology center´s results between the years 2012 and 2021 in the actual national and European guidelines context.  

Methods

The retrospective unicentric observational study, national and European guidelines review.

Results

In the observation period, 715 endometrial cancer patients were treated in our clinic, and 636 of them underwent surgical treatment (89%). Concerning lymph node staging, firstly there is a clear trend of expanding lymphadenectomy to the paraaortic area, followed by the sentinel node biopsy introduction in 2018 and 2019, and finally, the complete transition to this method as the main staging procedure in 2021, when this examination was performed in 73% of surgeries, even with high-risk cancers limited to the uterus. Within the sentinel node biopsy expansion, a gradual decrease in laparotomy approach (maximum 41% in 2016, 18% in 2021), and blood loss (2012-2019 median 100 ml, with a decrease to 50 ml in 2020-2021) was evident. A hospitalization length stabilized at a median of 5-6 days.

Conclusions

Endometrial cancer surgical treatment has become a minimally invasive procedure for the majority of patients, and the average blood loss and hospitalization length have decreased. Sentinel node biopsy has become the preferred lymph node staging method.