A 55-year-old woman with FIGO Stage IA grade 1 endometrioid endometrial carcinoma undergoes total laparoscopic hysterectomy with bilateral salpingo-oophorectomy. Intraoperatively, the uterus is opened and tumor is found to invade 40% of myometrial thickness. No LVSI is present. Sentinel lymph node mapping was not performed. What is the most appropriate next step in management?
- A Proceed with full pelvic and para-aortic lymphadenectomy
- B No further surgery; surveillance is appropriate ✓
- C Adjuvant vaginal cuff brachytherapy only
- D Adjuvant external beam pelvic radiotherapy
Correct answer: B. No further surgery; surveillance is appropriate
Explanation
Stage IA grade 1 with less than 50% myometrial invasion and no LVSI carries a lymph node metastasis risk of less than 1%. The PORTEC and GOG-99 trials demonstrated that low-risk and low-intermediate-risk patients do not benefit from lymphadenectomy or adjuvant radiation. Sentinel lymph node mapping is optional but not mandatory in this low-risk scenario. Full lymphadenectomy does not improve survival and adds morbidity. Surveillance with regular follow-up is the standard of care.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.