Omentectomy in endometrial cancer : an evidence-based insight

Abstract

Omentectomy is the surgical removal of the omentum. It is a routine component of staging surgery for confirmed or suspected ovarian carcinoma; however there is currently no consensus regarding omentectomy in surgery performed for endometrial cancer. Additionally, the extent of omental resection in patients without macroscopic deposits is unclear. A systematic search of PubMed MEDLINE resources was performed using the MeSH terms ‘endometrium’ ‘uterus’ ‘omentum’ ‘surgery’ ‘neoplasms’, and ‘neoplasm metastasis’. The authors conducted a literature review of articles published through January 2016 to summarize the current evidence analyzing omental assessment in endometrial cancer and the repercussions its involvement could have on patient management and prognosis. Metastasis to the omentum is a significant finding in endometrial cancer cases as it indicates upstaging to Stage IV-B (FIGO 2009). Assessment for omental spread helps indicate whether neoplastic deposits are spread beyond the conventional radiotherapy field and assist decision-taking with regards to platinum therapy. Macroscopic assessment of the omentum at the time of abdominal surgery for endometrial carcinoma has been shown to be highly sensitive and specific, and thus advisable. Omental biopsies and histopathological examination are more likely to affect management planning in cases at high-risk of upstaging, these being poorly differentiated tumors (Grade 2 and above), non-endometroid cytologies, cases with > 50% myometrial invasion, or cervical or adnexal involvement of the tumor. Total omentectomy and thorough histological assessment is superior with regards to detection of neoplastic spread however presents a significant strain on hospital laboratory services. Maximal surgical cytoreduction including omentectomy has been shown to improve overall survival in Stage 3 or 4 patients with good performance status.