Comparisons Among Different Surgical Methods And Prognosis Of Early Stage Endometrial Carcinoma

Objective:As one of common female genital tract malignant tumors,the morbidity and death rate of endometrial carcinoma have become an increasing tendency in the past ten years or more.According to evidence-based medicine for endometrial cancer,in 2009,FIGO redefined the operative pathological stage of endometrial carcinoma.With the changes of ? A stage,the surgical methods selection has changed.This study is based on FIGO Staging in 2009 and analyzes the surgical options and prognosis of ? A stage endometrial carcinoma in Jilin University Second Hospital Gynecology Department in order to offer references to surgical methods selection.Methods:This study collects all low-risk[1](the depth of invasion less than 1/2 myometrium,G1 or G2,the diameter of cancer is less than 2cm)I A stage endometrial carcinoma who are received surgical treatment and diagnosed by post-operative pathology in Jilin University Second Hospital Gynecology Department from 1995.01.01-2015.12.31.For the patients who are diagnosed as ? A stage and I B stage from the year of 1995 to 2009,based on the 2009 FIGO Stage,these two stages are combined as new ? A stage.The cases which occurred after 2009 remains same.Surgical methods and prognoses in all cases of ? A stage are disposed by retro-respective analysis.Excel software is used for building database.IBM SPSS Statistics 21.0 is used for statistical analysis.Measurement data and its comparison among groups are compared by variance analysis.Enumeration data and its comparison among groups are compared by chi-square test or Fisher's exact test/t test.All statistical tests are two-sided.The significant differences are defined as P<0.05.Results:1.This study has collected 758 cases who are ? A stage endometrial carcinoma with low-risk factors.Among them,the number of the cases operated by hysterectomy is 33(4.35%);the number of the cases operated by uterus + double accessories dissection is 218(28.76%);the number of the cases operated by uterus+ double accessories dissection + pelvic lymph node±para-artic lymph nodes dissection is 507(66.89%).2.In ? A stage,the number of the cases that limit in endometrium is 155(20.45%).Among them,the number of the cases operated by hysterectomy is 16(10.32%);the number of the cases operated by uterus + double accessories dissection is 58(37.42%);the number of the cases operated by uterus + double accessories dissection+pelvic lymph node±para-artic lymph nodes dissection is 81(52.26%).3.In ? A stage,the number of the cases that the depth of invasion less than 1/2 myometrium is 603(79.55%).Among them,the number of the cases operated by is 17(2.82%);the number of the cases operated by uterus + double accessories dissection is 160(26.53%);the number of the cases operated by uterus +double accessories dissection + pelvic lymph node±para-artic lymph nodes dissection is 426(70.65%).4.In ? A stage,the cases that limit in endometrium when compared between lymph nodes dissection and no lymph nodes dissection show that the differences have statistical significant in the time of surgical operation,perioperative bleeding,intra-operative complications,postoperative complications,postoperative exhaust time,installing catheter time,hospitalization time after operation.In contrast,there is no statistical significant differences in recurrence/metastasis rate,5-year survival rate and disease free survival.5.In ? A stage,the cases that the depth of invasion less than 1/2 myometrium when compared between lymph nodes dissection and no lymph nodes dissection show that the differences have statistical significant in the time of surgical operation,perioperative bleeding,intra-operative complications,postoperative complications,postoperative exhaust time,installing catheter time,hospitalization time after operation.In contrast,there is no statistical significant differences in recurrence/metastasis rate,5-year survival rate and disease free survival.6.For patients who are low-risk ? A stage endometrial carcinoma and the age is less than 40 year-old,the invasion limits in endometrium,there is no statistical significant difference in recurrence/metastasis rate and disease free survival between hysterectomy and uterus + double accessories dissection.But in 5-year survival rate,uterus + double accessories dissection is lower than hysterectomy and there is statistical significant difference.7.For patients who are low-risk ? A stage endometrial carcinoma and the age is less than 40 year-old,the depth of invasion less than 1/2 myometrium,there is no statistical significant difference in recurrence/metastasis rate and disease free survival between hysterectomy and uterus + double accessories dissection.But in 5-year survival rate,uterus+double accessories dissection is lower than hysterectomy and there is statistical significant difference.Conclusions:1.For patients with low-risk ? A stage endometrial carcinoma,no matter the invasion limits in endometrium or less than 1/2 myometrium,lymph nodes dissection could not improve prognosis.In other side,lymph nodes dissection increases the time of surgical operation,peri-operative bleeding,intra/post operative complications rate and recovery time after surgical operations.2.For young patients(the age is less than 40 year-old)who are low-risk ? A stage endometrial carcinoma,no matter the invasion limits in endometrium or less than 1/2 myometrium,double accessories dissection could not reduce recurrence/metastasis and disease free survival.Keep double accessories is doable but it still needs more studies to confirm.