Annals of Surgical Oncology

, Volume 22, Issue 11, pp 3695–3700 | Cite as

Microscopic Omental Metastasis in Clinical Stage I Endometrial Cancer: A Meta-analysis

  • Won Duk Joo
  • Peter E. Schwartz
  • Thomas J. Rutherford
  • Seok Ju Seong
  • Junbeom Ku
  • Hyun Park
  • Sang Geun Jung
  • Min Chul Choi
  • Chan Lee
Gynecologic Oncology



A patient with early-stage endometrial cancer may possibly have microscopic metastasis in the omentum, which is associated with a poor prognosis. The purpose of this study was to identify risk factors for microscopic omental metastasis in patients with clinical stage I endometrial cancer to establish the indications for selective omentectomy.


We searched the PubMed, EMBASE, and Cochrane Library databases for published studies from inception to August 2014, using terms such as ‘endometrial cancer’ or ‘uterine cancer’ for disease, ‘omentectomy’ or ‘omental biopsy’ for intervention, and ‘metastasis’ for outcome. Two reviewers independently identified the studies that matched the selection criteria. We calculated the pooled risk ratios (RRs) with 95 % confidence intervals (CI) of each surgicopathologic finding for microscopic omental metastases in clinical stage I endometrial cancer. We also calculated the prevalence of microscopic omental metastases.


Among 1163 patients from ten studies, 22 cases (1.9 %) of microscopic omental metastases were found, which accounted for 26.5 % of all omental metastases. Positive lymph nodes (RR 8.71, 95 % CI 1.38–54.95), adnexal metastases (RR 16.76, 95 % CI 2.60–107.97), and appendiceal implants (RR 161.67, 95 % CI 5.16–5061.03) were highly associated with microscopic omental metastases.


Microscopic omental metastases were not negligible in patients with clinical stage I endometrial cancer. Those with a risk factor of microscopic omental metastases were recommended for selective omentectomy.


Endometrial Cancer Clinical Stage Endometrioid Adenocarcinoma Positive Cytology Cochrane Library Database 



This study was supported by a grant from the Korea Healthcare Technology R&D Project, Ministry of Health and Welfare, Republic of Korea (A070001). The study was presented as a poster abstract at the Society of Gynecologic Oncology 44th Annual Meeting on Women’s Cancer, Los Angeles, CA, USA, on 10 March 2013.


Won Duk Joo, Peter E. Schwartz, Thomas J. Rutherford, Seok Ju Seong, Junbeom Ku, Hyun Park, Sang Geun Jung, Min Chul Choi, and Chan Lee report no conflicts of interest.

Supplementary material

10434_2015_4443_MOESM1_ESM.eps (3.3 mb)
Supplementary Fig. 1s Forest plots, the risk of microscopic omental metastases and (a) positive lymph nodes; (b) adnexal metastases; (c) appendiceal implants; (d) positive cytology; (e) deep myometrial invasion (≥1/2); (f) histological grade 3 versus grade 1 and 2; (g) histological grade 3 and 2 versus grade 1. LN, lymph node; MM, myometrial. Supplementary material 1 (EPS 3368 kb)
10434_2015_4443_MOESM2_ESM.eps (149 kb)
Supplementary Fig. 2s Funnel plots of studies included in the meta-analysis of the risk of microscopic omental metastases and (a) positive lymph nodes; (b) adnexal metastases; (c) deep myometrial invasion (≥1/2); (d) histological grade 3 versus grade 1 and 2; (e) histological grade 3 and 2 versus grade 1. All studies lay inside the funnels with symmetric distribution, suggesting no publication bias in the meta-analysis. LN, lymph node; MM, myometrial Supplementary material 2 (EPS 148 kb)


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Copyright information

© Society of Surgical Oncology 2015

Authors and Affiliations

  • Won Duk Joo
    • 1
    • 2
  • Peter E. Schwartz
    • 1
  • Thomas J. Rutherford
    • 1
  • Seok Ju Seong
    • 2
  • Junbeom Ku
    • 3
  • Hyun Park
    • 2
  • Sang Geun Jung
    • 2
  • Min Chul Choi
    • 2
  • Chan Lee
    • 2
  1. 1.Department of Obstetrics, Gynecology and Reproductive SciencesYale University School of MedicineNew HavenUSA
  2. 2.Department of Obstetrics and GynecologyCHA University School of MedicineSeongnamRepublic of Korea
  3. 3.College of Literature, Science, and the ArtsUniversity of MichiganAnn ArborUSA

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