The morbidity of surgery and adjuvant radiotherapy in the management of endometrial carcinoma

A retrospective review of side effects and complications of treatment in 522 patients with endometrial cancer managed in a gyneoncology unit was conducted. This study evaluated 517 patients who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH BSO). Lymphadendectomy or lymph node sampling was performed with the primary surgery in 264 and 41 cases, respectively. Postoperative radiotherapy was given as external beam or vault brachytherapy. Serious morbidity included lymphedema, hemorrhage, and vaginal stenosis. Lymphadenectomy was associated with lymphedema and lymphocyst formation in 11% of the cases. Vascular injury associated with lymphadenectomy occurred in 0.7% of the cases; however, this was satisfactorily managed through adequate surgical training and experience by staff within the unit. The incidence of vaginal stenosis (54.7%) following postoperative vault brachytherapy was a particular concern for clinical follow-up and sexual function. Although many women were not sexually active prior to treatment, those who were had high levels of sexual dysfunction, even when vaginal stenosis was not present.