Surgery as the Standard of Care for Endometrial Cancer
For most women with uterine (endometrial) cancer, surgery is the primary — and often the only — treatment required. The surgical procedure consists of a total hysterectomy, bilateral salpingo-oophorectomy, and lymph node evaluation. Roughly 70% of women are diagnosed with Stage I disease, where surgery alone achieves five-year survival rates exceeding 90%.
Why Minimally Invasive Surgery Is the Preferred Approach
The LAP2 trial — a landmark randomised trial of 2,600 women — established that laparoscopic hysterectomy for early endometrial cancer produces equivalent oncological outcomes to open surgery, with significant advantages:
- Shorter hospital stay (typically 1–2 nights vs 4–5 for laparotomy)
- Less blood loss and lower transfusion rates
- Fewer wound complications — important in obese patients
- Faster return to normal activities and work
- Equivalent lymph node yield and survival outcomes
Because endometrial cancer disproportionately affects older, obese women with medical comorbidities, the reduced physiological stress of laparoscopic surgery often makes it the safer option for women who would be higher-risk candidates for open laparotomy.
Robotic Surgery: Precision for Complex Cases
Robotic-assisted laparoscopic hysterectomy (using the da Vinci surgical system) extends the benefits of minimally invasive surgery to technically challenging cases — morbidly obese patients, those with extensive adhesions, or cases requiring para-aortic lymphadenectomy. The robotic platform provides 3D high-definition visualisation, wristed instrument tips with seven degrees of freedom, and tremor filtration.
Sentinel Lymph Node Mapping
Sentinel lymph node (SLN) mapping — injecting indocyanine green (ICG) dye into the cervix at the start of surgery and identifying the first lymph nodes to receive drainage — has emerged as a less morbid alternative to systematic pelvic lymphadenectomy, with comparable staging accuracy. It is now endorsed by ESGO and NCCN guidelines for Stage I–II low-to-intermediate risk endometrial cancer. Robotic surgery with near-infrared fluorescence imaging is ideal for SLN mapping.
When Adjuvant Treatment Is Needed
After surgery, final pathological staging determines whether adjuvant treatment (radiation therapy, chemotherapy, or both) is recommended. High-risk features include deep myometrial invasion, high-grade histology (Grade 3, clear-cell, serous), cervical involvement, and lymph node positivity. The decision is made in a multidisciplinary oncology meeting — a joint assessment by the surgeon, medical oncologist, and radiation oncologist.
For a consultation about minimally invasive uterine cancer surgery in Ahmedabad, contact Dr. Nishtha Tripathi Patel at +91 76988 00333.