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Surgery for endometrial cancer will remove the uterus, tubes and the ovaries. A frozen
section examination will be performed by the pathologist while you are under general
anaesthesia. The pathologist will tell me about the extent of the disease within
the uterus while you are asleep. Depending on the pathologists report you should
have a pelvic and/or aortic lymph node dissection. This means that I will remove
lymph glands from both side walls of the pelvis along the large vessels, which run
up into the abdomen. Ten to twenty per cent of early endometrial cancers spread
into lymph glands and it is very important to remove the lymph nodes in exactly
these patients exactly those patients. They
will need further postoperative treatment. Patients with very early endometrial
cancer with hardly any invasion of the cancer into the myometrium will not require
a lymph node dissection because the chance of lymph node involvement is extremely
low.
In rare cases radiotherapy or hormonal treatment may be an alternative to surgery.
However, these treatments are only recommended in patients who would not tolerate
surgery for medical reasons.
Before the operation imaging (X-ray and CT scan) and blood tests are routine measures
and give useful information prior to surgery. Usually no bowel prep is required.
Please fast at least 6 hours prior to surgery. Please stop smoking before the operation
as it makes your postoperative management much easier.
The procedure requires general anaesthesia. I encourage patients to have an epidural
catheter inserted because it allows for appropriate pain control after the operation.
The procedure usually takes 2 to 3 hours and is carried out by a midline incision
through the abdominal wall or by laparoscopy.
When you wake up from general anaesthesia there will be some lines running in and
out of you. A drip will give you the necessary fluids, a catheter will drain the
urine from your bladder and the epidural catheter will allow for adequate pain control.
An oxygen mask will supply oxygen to the respiratory system. A drain may collect
body fluid from the inside of the abdomen. These lines will be removed once I am
happy that your body functions have returned to normal, which is usually after 24 to 48
hours.
The final histopathological report may take up to a week. It forms the basis for
the decision if any further treatment is required. In up to 20% of the patients
postopoerative radiotherapy is recommended. Vaginal radiotherapy is very well tolerated,
bears minimal side effects and is sufficient for most patients. Under certain conditions
I will recommend external beam radiotherapy. If radiotherapy is required I will
bring you in contact with the radiotherapist.
Surgery always carries risks. Before surgery, I do everything to minimise these risks.
I give antibiotics before I do the skin incision in order to avoid skin and other
infections. Commencing prior to surgery I give Heparin or calf compression stockings
in order to prevent the formation of blood clots in the legs. At surgery sterile
handling of instruments further reduces the risk of infectious complications. However,
there are some immanent risks of surgery for endometrial cancer:
Medical and anaesthetic risks associated with general anaesthetic, with epidural analgesia or with postoperative pain control do exist. In patients with pre-existing medical conditions these risks are obviously higher.
There is a risk of injury to pelvic organs, such as the bowel, the bladder, the ureters, blood vessels and nerves. These injuries usually get repaired during surgery. However, in a small proportion of patients these injuries are not recognised during surgery or injuries may even develop after surgery. Then another operation is required to repair those defects. Injury to big blood vessels may result in need of blood transfusion. Injury of nerves is common in patients who require removal of lymph nodes in the pelvis. Many patients will experience some numbness of the skin around the upper thigh.
Bladder dysfunction: Due to the dissection of the tissue around the bladder and the ureter the bladder sensation is disturbed. As a consequence most patients experience difficulties emptying their urinary bladder. Therefore a urinary catheter will stay in the bladder for up to 5 days. If the bladder dysfunction is still present after a week, the patient will be trained to perform self-catheterisation of the bladder. Bladder dysfunction beyond 4 weeks is extremely rare.
Lymph oedema: Lymphatic fluid usually drains from the legs via the lymph glands in the pelvis and the aorta back into the blood circulation. When lymph glands have to be removed, some fluid may accumulate in the legs (lymph oedema). The risk of lymph oedema is around 20% in patients who had to have a lymph node dissection.
If the ovaries were preserved, there is a risk in the range of 10 to 20% to develop ovarian cysts, which subsequently may require surgery.
Other possible complications include ...
Infections to the bladder, the abdominal wound, the lungs with resulting temperatures and septicaemia
Thromboembolic complications (formation of blood clots)
Numbness and swelling to the skin around the incision
Psychosexual changes
You need to stay in hospital for around one week if you had a laparotomy or one to
three days if you had a total laparoscopic hysterectomy. I recommend to give yourself
a break for the next few weeks. Especially I recommend to avoid intercourse, vaginal
tampons and full baths for the next 6 weeks.
Please notify me immediately if your condition becomes worse after you have been
discharged from hospital.
After surgery, you should be seen regularly for follow-up for at least 5 years. These
examinations will include PAP smears, pelvic examinations and sometimes imaging
methods.
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