Does the localisation of tumour at Stage I endometrial endometrioid adenocarcinoma have an impact on invasion of the tumour and individualisation of the surgical procedure?

Objective: To detect whether the localisation of the tumour has an impact on the dissemination of the tumour and whether or not surgical procedures should be individualized according to the localisation of the tumour. Material Method: 106 clinically surgically stage I endometrial endometrioid carcinoma cases treated multi-institutionally at Gulhane Military Medical Academy (GATA) and Dr. Zekai Tahir Burak (ZTB) Women's Health Education and Research Hospital Gynecologic Oncology Units in the last five years were evaluated retrospectively. The tumours localised near the internal cervical os and not invading the cervical canal were accepted as lower uterine segment (LUS) localisation and the corporal location as upper uterine segment (UUS) localisation. Results: Tumour localisation was more frequent in the upper segment than LUS (85.9% vs 14.1%). There was no statistically significant difference between only endometrial and only serous invasion rates. Myometrial invasion less than one-half was significantly higher in the UUS group than the LUS group (p < 0.05). Lymph vascular space involvement rate was significantly higher in the LUS group (60%, 9/15) than the UUS group (23 %, 21/91), (p < 0.01). Positive peritoneal cytology rate was 20% (3/15) in the LUS group and 6.6% (6/91) in the UUS group (p > 0.05). Conclusion: Patients with LUS involvement should be considered as high-risk patients. Thus more expanded surgery must be taken into consideration. In this study a limitation was the low number of patients with LUS involvement. Larger prospective studies are necessary to confirm our results.