Skip to main content
SpringerLink
Log in

Operative Therapie des Endometriumkarzinoms

Surgery for endometrial cancer

  • Leitthema
  • Published:
Der Gynäkologe Aims and scope

Zusammenfassung

Im April 2018 wurde die erstmalig eine S3-Leitlinie zur Diagnostik, Therapie und Nachsorge des Endometriumkarzinoms, gefördert durch das Leitlinienprogramm Onkologie, publiziert. Auf der Grundlage aktueller systematischer Literaturrecherchen wurden von einer interdisziplinären, multiprofessionellen Gruppe Empfehlungen konsentiert. Neuerungen im Vergleich zur Vorversion betreffen den Verzicht auf die systematische Durchführung einer radikalen Hysterektomie im Stadium 2, die differenzierte Indikationsstellung zur systematischen pelvinen und paraaortalen Lymphonodektomie sowie die Auswahl der Zugangswege. Weitere Themen sind die Anwendung der Sentinel-Lymphonodektomie und das Vorgehen bei fortgeschrittenen Karzinomen und Karzinosarkomen

Abstract

In April 2018, a new German S3 guideline supported by the Leitlinienprogramm Onkologie (Guideline Program—Oncology) on diagnosis, treatment, and aftercare of endometrial cancer was published. Based on current systematic literature reviews, consensus recommendations were established by an interdisciplinary multiprofessional group. Compared to prior versions of this guideline, adaptions have been made regarding routine radical hysterectomy for stage 2 cancer, the differential indications for systematic pelvic and periaortic lymph node dissection as well as mode of peritoneal access. Further aspects are the use of sentinel lymph node dissection and the surgical approach for advanced stages and carcinosarcomas.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Alay I, Turan T, Ureyen I, Karalok A, Tasci T, Ozfuttu A et al (2015) Lymphadenectomy should be performed up to the renal vein in patients with intermediate-high risk endometrial cancer. Pathol Oncol Res 21:803–810

    Article  Google Scholar 

  2. ASTEC study group, Kitchener H, Swart AM, Qian Q, Amos C, Parmar MK (2009) Efficacy of systematic pelvic lymphadenectomy in endometrial cancer (MRC ASTEC trial): a randomised study. Lancet 373:125–136

    Article  Google Scholar 

  3. Ballester M, Dubernard G, Lecuru F, Heitz D, Mathevet P, Marret H et al (2011) Detection rate and diagnostic accuracy of sentinel-node biopsy in early stage endometrial cancer: a prospective multicentre study (SENTI-ENDO). Lancet Oncol 12:469–476

    Article  Google Scholar 

  4. Barlin JN, Puri I, Bristow RE (2010) Cytoreductive surgery for advanced or recurrent endometrial cancer: a meta-analysis. Gynecol Oncol 118:14–18

    Article  Google Scholar 

  5. Bendifallah S, Koskas M, Ballester M, Genin AS, Darai E, Rouzier R (2012) The survival impact of systematic lymphadenectomy in endometrial cancer with the use of propensity score matching analysis. Am J Obstet Gynecol 206. https://doi.org/10.1016/j.ajog.2012.03.027

    Article  PubMed  Google Scholar 

  6. Benedetti Panici P, Basile S, Maneschi F, Lissoni AA, Signorelli M, Scambia G et al (2008) Systematic pelvic lymphadenectomy vs. no lymphadenectomy in early-stage endometrial carcinoma: randomized clinical trial. J Natl Cancer Inst 100:1707–1716

    Article  Google Scholar 

  7. Cantrell LA, Blank SV, Duska LR (2015) Uterine carcinosarcoma: a review of the literature. Gynecol Oncol 137:581–588

    Article  Google Scholar 

  8. Chan JK, Gardner AB, Taylor K, Thompson CA, Blansit K, Yu X et al (2015) Robotic versus laparoscopic versus open surgery in morbidly obese endometrial cancer patients – a comparative analysis of total charges and complication rates. Gynecol Oncol 139:300–305

    Article  Google Scholar 

  9. Cormier B, Rozenholc AT, Gotlieb W, Plante M, Giede C, Communities of Practice Group of Society of Gynecologic Oncology of C (2015) Sentinel lymph node procedure in endometrial cancer: a systematic review and proposal for standardization of future research. Gynecol Oncol 138:478–485

    Article  Google Scholar 

  10. Darai E, Dubernard G, Bats AS, Heitz D, Mathevet P, Marret H et al (2015) Sentinel node biopsy for the management of early stage endometrial cancer: long-term results of the SENTI-ENDO study. Gynecol Oncol 136:54–59

    Article  Google Scholar 

  11. Dowdy SC, Borah BJ, Bakkum-Gamez JN, Weaver AL, McGree ME, Haas LR et al (2012) Prospective assessment of survival, morbidity, and cost associated with lymphadenectomy in low-risk endometrial cancer. Gynecol Oncol 127:5–10

    Article  CAS  Google Scholar 

  12. Eltabbakh GH, Piver MS, Hempling RE, Shin KH (1997) Excellent long-term survival and absence of vaginal recurrences in 332 patients with low-risk stage I endometrial adenocarcinoma treated with hysterectomy and vaginal brachytherapy without formal staging lymph node sampling: report of a prospective trial. Int J Radiat Oncol Biol Phys 38:373–380

    Article  CAS  Google Scholar 

  13. Frost JA, Webster KE, Bryant A, Morrison J (2015) Lymphadenectomy for the management of endometrial cancer. Cochrane Database Syst Rev 9:CD7585

    Google Scholar 

  14. Galaal K, Bryant A, Fisher AD, Al-Khaduri M, Kew F, Lopes AD (2012) Laparoscopy versus laparotomy for the management of early stage endometrial cancer. Cochrane Database Syst Rev:CD6655. https://doi.org/10.1002/14651858.CD006655

    Article  PubMed  Google Scholar 

  15. Johnson N, Bryant A, Miles T, Hogberg T, Cornes P (2011) Adjuvant chemotherapy for endometrial cancer after hysterectomy. Cochrane Database Syst Rev CD003175. https://doi.org/10.1002/14651858.cd003175.pub2

    Article  PubMed  PubMed Central  Google Scholar 

  16. Kim HS, Suh DH, Kim MK, Chung HH, Park NH, Song YS (2012) Systematic lymphadenectomy for survival in patients with endometrial cancer: a meta-analysis. Jpn J Clin Oncol 42:405–412

    Article  Google Scholar 

  17. Koskas M, Chereau E, Ballester M, Dubernard G, Lecuru F, Heitz D et al (2013) Accuracy of a nomogram for prediction of lymph-node metastasis detected with conventional histopathology and ultrastaging in endometrial cancer. Br J Cancer 108:1267–1272

    Article  CAS  Google Scholar 

  18. Lambrou NC, Gomez-Marin O, Mirhashemi R, Beach H, Saloma E, Almeida-Parra Z et al (2004) Optimal surgical cytoreduction in patients with Stage III and Stage IV endometrial carcinoma: a study of morbidity and survival. Gynecol Oncol 93:653–658

    Article  Google Scholar 

  19. Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2018) Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom, Langversion 0.1, 2018, AWMF Registernummer: 032/034-OL. http://www.leitlinienprogramm-onkologie.de/leitlinien/endometriumkarzinom/. Zugegriffen: 27. Juli 2018

    Google Scholar 

  20. Lopez-De la Manzanara Cano C, Cordero Garcia JM, Martin-Francisco C, Pascual-Ramirez J, Parra CP, Cespedes Casas C (2014) Sentinel lymph node detection using 99mTc combined with methylene blue cervical injection for endometrial cancer surgical management: a prospective study. Int J Gynecol Cancer 24:1048–1053

    Article  Google Scholar 

  21. Mariani A, Webb MJ, Keeney GL, Haddock MG, Calori G, Podratz KC (2000) Low-risk corpus cancer: is lymphadenectomy or radiotherapy necessary? Am J Obstet Gynecol 182:1506–1519

    Article  CAS  Google Scholar 

  22. Mariani A, Dowdy SC, Cliby WA, Gostout BS, Jones MB, Wilson TO et al (2008) Prospective assessment of lymphatic dissemination in endometrial cancer: a paradigm shift in surgical staging. Gynecol Oncol 109:11–18

    Article  Google Scholar 

  23. Nemani D, Mitra N, Guo M, Lin L (2008) Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecol Oncol 111:82–88

    Article  Google Scholar 

  24. Odagiri T, Watari H, Kato T, Mitamura T, Hosaka M, Sudo S et al (2014) Distribution of lymph node metastasis sites in endometrial cancer undergoing systematic pelvic and para-aortic lymphadenectomy: a proposal of optimal lymphadenectomy for future clinical trials. Ann Surg Oncol 21:2755–2761

    Article  Google Scholar 

  25. O’Malley DM, Smith B, Fowler JM (2015) The role of robotic surgery in endometrial cancer. J Surg Oncol 112:761–768

    Article  Google Scholar 

  26. Setiawan VW, Yang HP, Pike MC, McCann SE, Yu H, Xiang YB et al (2013) Type I and II endometrial cancers: have they different risk factors? J Clin Oncol 31:2607–2618

    Article  Google Scholar 

  27. Shih KK, Yon E, Gardner GJ, Barakat RR, Chi DS, Leitao MM (2011) Surgical cytoreduction in stage IV endometrioid endometrial carcinoma. Gynecol Oncol 122:608–611

    Article  CAS  Google Scholar 

  28. Sueoka K, Umayahara K, Abe A, Usami T, Yamamoto A, Nomura H et al (2014) Prognosis for endometrial cancer patients treated with systematic pelvic and para-aortic lymphadenectomy followed by platinum-based chemotherapy. Int J Gynecol Cancer 24:1356

    Article  Google Scholar 

  29. Takano M, Ochi H, Takei Y, Miyamoto M, Hasumi Y, Kaneta Y et al (2013) Surgery for endometrial cancers with suspected cervical involvement: is radical hysterectomy needed (a GOTIC study)? Br J Cancer 109:1760–1765

    Article  CAS  Google Scholar 

  30. Tanner EJ, Leitao MM Jr., Garg K, Chi DS, Sonoda Y, Gardner GJ et al (2011) The role of cytoreductive surgery for newly diagnosed advanced-stage uterine carcinosarcoma. Gynecol Oncol 123:548–552

    Article  Google Scholar 

  31. Todo Y, Kato H, Kaneuchi M, Watari H, Takeda M, Sakuragi N (2010) Survival effect of para-aortic lymphadenectomy in endometrial cancer (SEPAL study): a retrospective cohort analysis. Lancet 375:1165–1172

    Article  Google Scholar 

  32. Walker JL, Piedmonte MR, Spirtos NM, Eisenkop SM, Schlaerth JB, Mannel RS et al (2009) Laparoscopy compared with laparotomy for comprehensive surgical staging of uterine cancer: Gynecologic Oncology Group Study LAP2. J Clin Oncol 27:5331–5336

    Article  Google Scholar 

  33. Wright JD, Burke WM, Wilde ET, Lewin SN, Charles AS, Kim JH et al (2012) Comparative effectiveness of robotic versus laparoscopic hysterectomy for endometrial cancer. J Clin Oncol 30:783–791

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Landesfrauenklinik, Gynäkologische Onkologie der Universität Witten/Herdecke, HELIOS Universitätsklinikum Wuppertal, Heusnerstraße 40, 42283, Wuppertal, Deutschland

    Markus C. Fleisch

  2. Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Essen, Essen, Deutschland

    Rainer Kimmig

  3. Frauenklinik Charité, Campus Virchow-Klinikum, Universitätsmedizin Berlin, Berlin, Deutschland

    Werner Lichtenegger

  4. Frauenklinik, Universitätsspital Basel, Basel, Deutschland

    Christian Kurzeder

  5. Frauenklinik, HELIOS Klinikum Krefeld, Krefeld, Deutschland

    Michael Friedrich

  6. Klinik und Poliklinik für Frauenheilkunde und Fortpflanzungsmedizin, Universitätsklinikum Jena, Jena, Deutschland

    Ingo Runnebaum

  7. Universitätsklinik für Frauenheilkunde, Inselspital Bern, Bern, Deutschland

    Michael Mueller

  8. Zentrum für Innere Medizin, Universitätsklinikum Heidelberg, Heidelberg, Deutschland

    Gerlinde Egerer

  9. Klinik für Frauenheilkunde, Geburtshilfe und Reproduktionsmedizin, Universitätsklinikum des Saarlandes, Homburg, Deutschland

    Ingolf Juhasz-Böss

  10. Frauenklinik, Universitätsklinikum Erlangen, Erlangen, Deutschland

    Matthias W. Beckmann

Authors
  1. Markus C. Fleisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rainer Kimmig
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Werner Lichtenegger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Christian Kurzeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Michael Friedrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ingo Runnebaum
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Michael Mueller
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gerlinde Egerer
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Ingolf Juhasz-Böss
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matthias W. Beckmann
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

Arbeitsgruppe Operative Therapie der S3-Leitlinienkommission

Corresponding author

Correspondence to Markus C. Fleisch.

Ethics declarations

Interessenkonflikt

M.C. Fleisch, R. Kimmig, W. Lichtenegger, C. Kurzeder, M. Friedrich, I. Runnebaum, M. Mueller, G. Egerer, I. Juhasz-Böss und M.W. Beckmann geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Additional information

Redaktion

G. Emons, Göttingen

Teile dieses Beitrags entstammen wörtlich aus dem Leitlinienprogramm Onkologie (Deutsche Krebsgesellschaft, Deutsche Krebshilfe, AWMF) (2018) Diagnostik, Therapie und Nachsorge der Patientinnen mit Endometriumkarzinom [19].

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fleisch, M.C., Kimmig, R., Lichtenegger, W. et al. Operative Therapie des Endometriumkarzinoms. Gynäkologe 51, 1024–1031 (2018). https://doi.org/10.1007/s00129-018-4339-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00129-018-4339-9

Schlüsselwörter

Keywords

Search

Navigation