ABSTRACT

The cornerstone of therapy for patients with epithelial endometrial cancer has been surgery, specifically extra-fascial hysterectomy (EH) and bilateral salpingo-oophorectomy. Historically, patients with endometrial cancer were clinically staged and the use of preoperative or postoperative radiation therapy was extremely common. During the 1980s, it became evident that clinical staging understaged a large number of patients with endometrial cancer. In 1988, data from several trials led the International Federation of Gynecology and Obstetrics (FIGO) to recommend a change from clinical staging to surgical staging. Since that time, surgical staging has been more routinely incorporated into the management of women with endometrial cancer. Surgical staging includes EH, bilateral salpingo-oophorectomy, peritoneal cytology, and pelvic and para-aortic lymphadenectomy. This strategy allows one to accurately determine the extent of disease, thus allowing for better assessment of prognosis and for individualization of postoperative therapy. Fortunately, the majority of patients with endometrial cancer have stage I disease (i.e., disease confined to the uterus); however, a subset of these early stage patients, even those who received adjuvant therapy for high-risk factors, will relapse either locally in the pelvis, distantly, or a combination of both. Approximately 25% of all patients with endometrial cancer will have extrauterine disease at the time of diagnosis including

metastases to the cervix, adnexa, upper abdomen, and lymph nodes. Distant metastases to the lung, brain, liver, and bone occur more commonly in patients with recurrent disease. The purpose of this chapter is to evaluate the surgical options for patients with advanced and relapsed epithelial cancer of the uterus.