Is there a need for surgical staging of uterine endometrioid adenocarcinomas grade 1 and 2?

Background and aims: Our institution has followed the Danish Guidelines for treatment of uterine carcinomas including staging lymphadenectomy in the pelvis for endometrioid adenocarcinomas (EA) grade 1 and 2 with deep myometrial invasion (>50%) or cervical involvement. We wanted to find out how often staging lymphadenectomy resulted in upstaging and further therapy. Methods: Retrospective analysis of records for all patients with endometrial cancer at Odense University Hospital, Odense, Denmark from Jan. 1st 2004 to Dec. 31st 2013. The focus was on EA grade 1 and 2. Patients with this histology and FIGO stage IB, II and IIIC were evaluated. Results: 467 patients had EA grade 1 in their hysterectomy specimen. 85 were stage IB, 54 stage II and 8 stage IIIC. 58 (68%) of stage IB and 33 (61%) of stage II had staging lymphadenectomy with negative nodes. If positive they were included in stage IIIC. In 32/39% lymphadenectomy was omitted due to old age and/or comorbidity. In grade 1, stage IIIC, 6 of the 8 patients had cervical involvement (+/- deep myometrial invasion) and only 2 had deep invasion without cervical involvement. For grade 2 the numbers are: total 246, 53 stage IB, 33 stage II and 9 stage IIIC. 39 (74%) stage IB and 19 (58%) stage II were staged. Of the 9 stage IIIC 5 had cervical involvement and deep myometrial invasion. 4 had only deep invasion. Conclusion: Staging of stage II, grade 1 and 2 EA seems reasonable, while it could be omitted in stage IB.