Use of preoperative and intraoperative parameters for decision making in ovarian preservation in endometrial adenocarcinoma

Objective: To investigate the characteristics of endometrial adenocarcinoma (EC) patients with ovarian metastasis and to define criteria for ovarian preservation by using preoperative and intraoperative parameters. Methods: Clinical and pathological characteristics of patients with EC were reviewed. Following univariate and multivariate analysis to determine factors associated with ovarian metastasis, different sets of criteria were analyzed to determine the subgroup of patients with negligible risk of ovarian metastasis. Results: 725 patients were included. Ovarian involvement was detected in 9.1% of patients. Univariate analysis showed that tumor diameter, grade, histological type, myometrial invasion, peritoneal cytology, lymphovascular space invasion (LVSI), cervical invasion, omental and lymph node metastasis are significantly associated with ovarian metastasis while only LVSI, cervical invasion, omental and lymph node involvement were significant on multivariate analysis. By using preoperative and intraoperative parameters only, no ovarian involvement was seen in patients with endometrioid tumor of any grade without myometrial invasion, patients with grade 1, less than 2 cm endometrioid tumors without deep myometrial invasion and in patients younger than 45 years with grade 1 or 2 endometrioid tumors without deep myometrial invasion. Conclusion: Ovarian involvement in cases of endometrial carcinoma occurs in less than 10% of cases. Ovarin preservation could be considered in cases of endometrioid adenocarcinoma that meet certain preoperative and intraoperative criteria.

Endometrial adenocarcinoma; Ovarian metastasis; Oophorectomy; Ovarian preservation

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