From the Guidelines
Omentectomy is usually included for clear cell, serous, and sometimes carcinosarcoma histologies given an increased risk of advanced-stage disease at diagnosis and relatively low morbidity with the procedure. The decision to perform an omentectomy in a patient who underwent abdominal hysterectomy and regional lymph node excision for cancer depends on several factors, including the specific type of cancer, its stage, histologic grade, and extent of spread.
- For endometrial cancer, omentectomy is typically recommended for high-grade histologies (such as serous or clear cell carcinomas) or when there is concern for advanced disease, as stated in the study by 1.
- The study by 1 also mentions that omentectomy has a relatively low morbidity, which supports its inclusion in the surgical staging of endometrial cancer for high-risk cases.
- However, for early-stage, low-grade endometrial cancers confined to the uterus, omentectomy may not be necessary, as the risk of microscopic involvement in the absence of visible macroscopic disease is low, according to 1.
- The final determination should be made by the gynecologic oncologist based on intraoperative findings, preoperative imaging, and the overall clinical picture of the patient's disease, taking into account the latest recommendations and guidelines, such as those provided by 1.
From the Research
Indication for Omentectomy
The patient underwent abdominal hysterectomy + regional lymph node excision for cancer, and the question is whether she is indicated for omentectomy.
- The study 2 suggests that routine omentectomy is unnecessary in surgical staging of endometrioid endometrial cancer unless there is suspicion of gross metastases during intraoperative examination.
- There is no direct evidence in the provided studies that links abdominal hysterectomy + regional lymph node excision to the necessity of omentectomy.
- The studies focus on the role of lymphadenectomy in endometrial cancer, with 3, 4, and 5 discussing the benefits and limitations of pelvic and para-aortic lymphadenectomy.
- Study 6 compares the morbidity and mortality of patients with endometrial cancer who had total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) alone or with pelvic and para-aortic lymphadenectomy, but does not mention omentectomy.
Omentectomy in Endometrial Cancer
- The provided studies do not establish a clear indication for omentectomy in patients who have undergone abdominal hysterectomy + regional lymph node excision for endometrial cancer.
- Study 2 is the only one that mentions omentectomy, and it suggests that it is not necessary unless there is suspicion of gross metastases.
- The other studies focus on lymphadenectomy and do not provide evidence for or against omentectomy in this context.