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Hysterectomy and bilateral salpingo-oophorectomy for endometrial cancer

General

For confirmed endometrial cancer, the standard procedure is removal of the uterus (hysterectomy) and both ovaries (bilateral salpingo-oophorectomy, or BSO). The surgeon also checks for metastasis to other parts of the adomen and lymph nodes.

Due to the possibility of metastasis to the peritoneum and lymph nodes from serous papillary and clear cell tumors, the omentum (omentectomy) and lymph nodes are also removed. 

In tumors of low differentiation, serous papillary carcinoma, clear cell carcinomas, and carcinosarcomas, there is a high risk for metastases to lymph nodes. Lymph node staging in the pelvis and paraaortic is therefore always performed for these tumors. 

For high and moderately differentiated endometrioid tumors, the decision for lymph node staging depends on depth of invasion into the myometrium evaluated from MRI. Metastases to the adnexae or synchronous primary tumors of the adnexae are confirmed in about 20% of patients, therefore it is recommended to remove these by surgery.

This operation is preferably performed by endoscopy if the situation allows.

 

Indication

  • Suspect or confirmed endometrial cancer

Goal

  • Curative treatment and staging

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