Extrauterine spread is an important prognostic factor in endometrial carcinoma and occult metastases to the omentum have been reported in patients with early stage endometrial cancer. Several studies have indicated that occult metastases to the omentum are neglected clinically during primary surgicopathologic staging in early stage endometrial carcinoma cases.

OBJECTIVE: To determine the incidence of omental metastasis in patients with early stage endometrial carcinoma and to correlate surgicopathologic factors with omental metastasis.

METHODS: This was a cross-sectional study on patients diagnosed preoperatively with early stage (Stages I and II) endometrial carcinoma in a tertiary hospital from May 2004 to July 2006. After standard surgical staging procedures in the form of extrafascial hysterectomy with bilateral-salpingo-oophorectomy, peritoneal fluid cytology, bilateral pelvic lymph node dissection, para-aortic lymph node sampling, an infracolic omentectomy was performed. Surgicopathologic factors were then analyzed using Spearman's Rho to determine its correlation with omental metastasis.

RESULTS: Omental metastasis was detected in 2 of 96 patients (2.08%) diagnosed pre-operatively with early stage endometrial carcinoma. No statistical correlation was found with surgicopathologic variables such as stage, histology, grade, tumor size, isthmus-cervical extension, lymphovascular space invasion, peritoneal fluid cytology, pelvic and para-aotic lymph node metastasis (p > 0.05). There was, however, a statistically significant correlation between the presence of > 50% myometrial invasion and omental metastasis (p = 0.012). No complications ensued from the performance of infracolic omentectomy.

CONCLUSION: In patients with full myometrial invasion, infracolic omentectomy may be included in the surgical staging because of the possibility of omental involvement in spite of apparently early stage disease especially in the presence of gross abnormalities in the omentum. (Author)