A 65-year-old woman with Stage II (FIGO 2009) grade 2 endometrioid adenocarcinoma with cervical stromal invasion is planned for surgery. What is the appropriate surgical procedure?

• A Simple total hysterectomy with bilateral salpingo-oophorectomy
• B Total hysterectomy followed by adjuvant radiotherapy, avoiding radical surgery
• C Supracervical hysterectomy with bilateral salpingo-oophorectomy
• D Radical (modified radical or Type III) hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy ✓

Explanation

Stage II endometrial carcinoma with cervical stromal invasion requires radical or modified radical hysterectomy (Type II or III) with bilateral salpingo-oophorectomy and pelvic lymphadenectomy to achieve adequate surgical margins. Simple hysterectomy leaves residual cervical tissue at risk of recurrence. Supracervical hysterectomy is contraindicated. Preoperative radiotherapy followed by simple hysterectomy is an alternative for surgically unfit patients, but radical hysterectomy is the preferred surgical approach for operable Stage II disease.

Reference: Bailey and Love's Short Practice of Surgery, 28th ed.

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Written and medically reviewed by the StethoPrep medical team.