Is Omentectomy Necessary for Non-Endometrioid Endometrial Cancer

Abstract

Background: In subtypes of non-endometrioid endometrium cancers (non-ECC), it is not clear whether the omentectomy is a part of debulking if visual assessment is normal. Recently, the ESMO-ESGO-ESTRO Endometrial Consensus Conference Working Group in their report titled “Endometrial Cancer: diagnosis, treatment and follow-up” recommended that omentectomy be performed in the serous subtype, but not in carcinosarcoma, undifferentiated endometrial carcinoma or clear cell. In this study, the question is whether omentectomy should be a part of a staging procedure in patients with non-ECC. Besides, the sensitivity and specificity of the visual assessment of omentum were analyzed. Methods: Patients diagnosed with non-ECC in 2 gynecological oncology clinics between 2005 and 2015 were retrospectively reviewed. Occult (absence of visible lesions) and gross (presence of visible lesions) omental metastasis rates of histological subtypes were analyzed. Results: We identified 218 patients with non-ECC. Thirty-four of them (15.1%) had omental metastases and 44.1% of these metastases (n = 15) were occult metastases. The sensitivity of the surgeon's visual assessment of an omentum (positive or negative) was 0.55. The highest rate of omental metastasis was found in carcinosarcoma followed by serous, mixed subtypes, and clear-cell (20.4, 17.3, 16.6, 10.0%, respectively). Adnexal metastasis was the only factor associated with occult omental metastasis (p = 0.003). Conclusion: Omental metastases occur too often to omit omentectomy during surgical procedures for non-ECC regardless of histological subtypes, and visual assessment is insufficient in recognizing the often occult metastases. Omentectomy should be a part of the staging surgery in patients with non-ECC.

The role of omentectomy in the surgical treatment of uterine serous carcinoma

“…In our series, 11 patients were upstaged from stage I to stage IV after omentectomy. Our multivariate analysis showed that adnexal invasion was a risk factor for omental involvement, which is consistent with the results obtained in Kaban’s study [14]. Thus, adnexal involvement might predict the need for omentectomy.…”

“…The prevalence of omental metastasis in USC ranged from 10 to 17.4% [[12], [13], [14]]. Even in women with noninvasive serous carcinoma limited to the endometrium, the occurrence of omental metastases was as high as 5.1–9.8% (58/591) in clinical stage I nonendometrioid type endometrial cancer [15,16].…”

“…A similar result was found in our study, as the occurrence of occult omental disease was 9.1%. Kaban et al reported that 44.1% of omental diseases exhibited occult metastases in nonendometrioid-type endometrial cancers, and the sensitivity of a surgeon’s visual assessment of the omentum (positive or negative) was 0.55 [14]. This suggests that visual assessment of the omentum is insufficient for recognizing these often occult metastases.…”

Investigation of extra-uterine tumor dissemination of endometrial cancers with myometrial invasion less than 50% according to hystologic subtypes

“…[10] The National Comprehensive Cancer Network (NCCN) guideline supports that all of the non-endometrioid types are at high risk and that the omentectomy is part of the staging surgery. [11] Kaban et al 's [12] study showed that all patients with non-endometrioid type omentectomy were proposed, which seems reasonable that omentectomy is part of the staging surgery in non-endometrioid histologies.…”

ESGO/ESTRO/ESP guidelines for the management of patients with endometrial carcinoma

“…In a randomised controlled trial comparing modified radical (Piver-Rutledge class II) hysterectomy to the standard extrafascial (Piver-Rutledge class I) or simple total hysterectomy in stage I endometrial carcinoma, Signorelli et al showed no differences in locoregional control and survival [172]. The high risk of microscopic omental metastases in stage I serous and undifferentiated endome-trial carcinoma and in carcinosarcoma suggests that omentectomy should be part of staging surgery in these patients [173]. The low rate of omental metastases in apparent clinical stage I endometrioid and clear cell carcinoma does not justify the procedure [174].…”