4.3.1 Surgery

Surgery is the primary treatment for endometrial cancer. The type of surgery offered will depend on several factors such as the extent and grade of disease, the patient’s age, medical comorbidities, performance status and desire to retain fertility.

For patients with early-stage endometrial cancer that is confined to the uterus, a hysterectomy and bilateral salpingo-oophorectomy (pelvic lymph node assessment including sentinel lymph node biopsy where appropriate) is the standard surgical approach, unless the patient opts for a fertility-sparing option (NCCN 2017).

Total abdominal hysterectomy (laparotomy) is used less frequently today in favour of laparoscopy or robotic surgery, a minimally invasive option providing equivalent results with fewer complications (Cancer Council Australia 2014; Colombo et al. 2016; ESMO 2013). Lymphadenectomy may be considered in select patients (Cancer Council Australia 2014).

For premenopausal patients, post-surgery assessment of the effects of surgical menopause must be ongoing.

Timeframe for starting treatment

Surgery should occur within four weeks of the MDM, provided the patient is medically fit.

Training and experience required of the surgeon

Gynaecological oncologist (FRANZCOG) with adequate training and experience in gynaecological cancer surgery and institutional cross-credentialing and agreed scope of practice within this area. In some cases, it may be appropriate for a specialist gynaecologist to perform the surgery, provided they are linked to a gynaecological cancer multidisciplinary team.

Documented evidence of the surgeon’s training and experience, including their specific (sub-specialty) experience with endometrial cancer and procedures to be undertaken, should be available.

Health service characteristics

To provide safe and quality care for patients having surgery, health services should have these features:

  • critical care support
  • 24-hour medical staff availability
  • appropriate nursing and theatre resources to manage complex surgery
  • 24-hour operating room access and intensive care unit
  • diagnostic imaging
  • pathology.