RADICAL HYSTERECTOMY FOR STAGE-I AND STAGE-II ENDOMETRIAL CARCINOMA - A RETROSPECTIVE ANALYSIS OF 179 CASES

Total hysterectomy with bilateral salpingo oophorectomy is the traditional treatment for endometrial carcinoma. In an effort to improve local control rates, we have surgically treated our Stage I and II patients with radical hysterectomy and pelvic lymphadenectomy (RH-PL). Between 1976 and 1987 we have treated 179 patients with endometrial adenocarcinoma (125 Stage I and 54 Stage II) with the following modalities. Uterovaginal brachytherapy (60 Gy) was performed first and then 6 weeks later an RH-PL was performed. Twenty-nine patients received external pelvic irradiation (45 Gy) because of tumor invasion beyond the internal two-thirds of the myometrium and/or lymph node involvement. The local control rate was 87% (92% for Stage I, 76% for Stage II). Distant metastases occurred in 24 patients (13%). Five-year actuarial survival rates were 80% for Stage I and 61% for Stage II patients. Prognostic factors were nodal status, histological grading, depth of tumor myometrial invasion, histologic status of the hysterectomy specimen, and peritoneal cytology. Late severe complications occurred for 13 patients (7%). These results are comparable to those published for patients treated with less extensive surgery. We conclude that such an extensive surgery (especially pelvic lymphadenectomy) appears to be useless for all patients with bad prognostic factors requiring pelvic external irradiation. We only still perform external iliac node samples for patients with Stage I grade 1 tumors without deep tumor invasion into the myometrium.