Guido M Rey Valzacchi, Michael W Burczynski, Ashley N Hamati, Sana Hatoum, Evan S Smith, Sarah H Kim, Jacqueline Feinberg, Vicky Makker, Sarah Chiang, Luisa Ricaurte Archila, Jennifer J Mueller, Nadeem R Abu-Rustum, Mario M Leitao
Microscopic omental disease in high-grade non-endometrioid endometrial carcinomas clinically confined to the uterus is rare and unlikely to impact treatment decisions. These data suggest that routine omental biopsies may not be necessary in this cohort of patients.
OBJECTIVE: The aim of this study was to assess the rate of microscopic omental metastasis in patients with clinical stage I serous, carcinosarcoma, clear cell, and un-differentiated endometrial carcinoma.
METHODS: We retrospectively identified all patients with newly diagnosed clinical stage I serous, carcinosarcoma, clear cell, and un-differentiated endometrial carcinoma undergoing primary surgery between January 2018 and December 2022 at our institution. We obtained the method of omental sampling from operative reports and reviewed final pathology reports to evaluate omental and peritoneal involvement. To report findings, we used descriptive statistics.
RESULTS: We identified a total of 248 patients: 145 (58.5%) serous, 71 (28.6%) carcinosarcoma, 23 (9.3%) clear cell, and 9 (3.6%) un-differentiated/de-differentiated. All but 9 (3.6%) patients had pre-operative imaging. The surgical approach was robotic-assisted laparoscopy in 184 (74.2%) patients, laparoscopy in 47 (19.0%), and open in 17 (6.9%). An omental biopsy was performed in 214 (86.3%) patients, an infra-colic omentectomy in 32 (12.9%), and a total omentectomy in 2 (0.8%). Microscopic omental disease was found in 1 (0.4%) patient with carcinosarcoma that also had metastatic disease in both sentinel lymph nodes on final pathology. Peritoneal biopsies of normal-appearing peritoneum were taken in 30 (12.1%) patients, and microscopic disease was found in 1 (3.3%) patient with serous carcinoma who also had a positive sentinel lymph node on final pathology. One intra-operative complication was reported when performing an infra-colic omentectomy robotically, and it was a thermal injury to the transverse colon, which was oversewn with multiple layers, including an omental patch.
CONCLUSIONS: Microscopic omental disease in high-grade non-endometrioid endometrial carcinomas clinically confined to the uterus is rare and unlikely to impact treatment decisions. These data suggest that routine omental biopsies may not be necessary in this cohort of patients.