Influence of Omental Biopsy on Adjuvant Treatment Field in Clinical Stage 1 Endometrial Carcinoma

Drs. J. Nieto,  R. Gornall, , P. Hogston, R. Woolas

St. Mary’s Hospital

Milton Road, Portsmouth
United Kingdom

Background: Conventional treatment for endometrial cancer is hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant radiotherapy for the approximately 50% of women with high risk features on pathological examination of the excised specimen. Over 30% of patients fail treatment on this protocol, half of them recurring at an extrapelvic site.
Methods: To determine the role of omental biopsy in the diagnosis of extrapelvic disease a prospective study was commenced in August 1997. From this date patients undergoing open abdominal surgery for endometrial cancer were consented for an omental biopsy. 100 consecutive women with clinical stage 1 endometrial cancer undergoing primary surgical treatment in our institution were analysed for this report.
Results: 80 women had an omental biopsy and 20 did not. Six patients had adenocarcinoma in the omentum. Four of these deposits were grossly suspicious in appearance and two were not clinically obvious. None of these patients had macrospcopic ovarian involvement. No other features of stage 4 disease were detected. Had this abdominal tumour not been diagnosed all 6 of these women would have had indications for adjuvant pelvic radiotherapy. No obvious morbidity attributable to this rapid and easily performed procedure were recorded.
Conclusions: Visual inspection and palpation of the omentum at the time of abdominal surgery for endometrial carcinoma is worthwhile and advisable. In addition, adopting a protocol of histological assessment upstaged a further two patients in this series. This data suggests that this simple technique might influence the prescription of adjuvant pelvic radiotherapy in approximately 1 in 10 women currently considered for such therapy as disease can be easily documented as having extended beyond the radiotherapy field.