Surgical management of patients with endometrial cancer and cervical involvement

Objective: To evaluate the role of extrafascial hysterectomy in the management of women with endometrial carcinoma and cervical involvement. Methods: A review of 238 medical records of patients with endometrial cancer treated at the Weiler Hospital of the Albert Einstein College of Medicine and Montefiore Medical Center from 3/86 to 3/91 was performed. Thirty-one patients were selected based on histopathologic documentation of cervical involvement in the surgical specimen. Fisher exact probability test, Kaplan-Meier and Log.Rank procedures were used for the statistical analysis of the data. Results: Two patients were excluded as they received preoperative radiotherapy. Nineteen patients had Stage II disease and ten mere found to have Stage III (two for positive washings, eight for positive pelvic and/or para-aortic nodes). Sixteen of 19 patients with Stage II disease received postoperative pelvic radiotherapy. Six patients with Stage III received postoperative radiotherapy, four with Stage III received chemotherapy. The probability of survival for Stage II patients was 72%, for Stage III 33% and the entire group was 60% (median follow-up 55 months). Conclusions: Extrafascial hysterectomy was performed without major complications in 86% of patients with endometrial carcinoma and microscopic cervical involvement. This procedure may be considered an adequate first line of treatment for patients without gross cervical spread of the disease.