The impact of COVID-19 pandemic on women with endometriosis: a retrospective cohort study on referral center population.

BACKGROUND: Patients with endometriosis are thought to have been impacted by the COVID-19 pandemic and estimates suggest that 6.2% of them were infected with SARS-CoV-2. METHODS: This is a retrospective cohort study enrolling 284 women at the Polyclinic of Modena between January 2020 and April 2021. Patients were given specific questionnaires to investigate COVID-19 infection and any changes in gynecological symptoms. All patients were also administered the Hospital Anxiety and Depression Syndrome (HADS) Questionnaire to assess the psychological impact of the COVID-19 pandemic. The primary outcome was to assess the clinical impact and any worsening of gynecological symptoms after COVID-19 infection; the secondary outcome was to evaluate the clinical and psychological impact of the COVID-19 pandemic in patients with endometriosis or chronic pelvic pain. RESULTS: A total of 170 women experienced COVID-19 infection, while 114 were consistently negative and asymptomatic for COVID-19. The two groups showed similar baseline. A total of 122 women with COVID-19 infection and 106 COVID-19 negative patients had already the vaccine administration with two doses of vaccine (72.20% vs. 93%, P=0.001). Among the 170 patients affected by COVID-19, 41 (24%) reported worsening gynecologic endometriosis symptoms, during the infection. According to our results, 196 of 284 reported changes in their gynecological health status during pandemic, and 84 reported symptomatic worsening (42.9%); 24% of patients with infection reported feeling slowed down vs. 15.8% of unaffected patients (P=0.065) and 44% of positive patients reported loss of interest in self-care vs. 31% of negative patients (P=0.055). CONCLUSIONS: Patients with endometriosis seemed to have worsening gynecological and psychological clinical status during the pandemic.

Sentinel lymph node biopsy in endometrial cancer: When, how and in which patients.

The role of nodal dissection in patients with endometrial cancer has been intensively studied in several studies. Historically, systematic pelvic and para-aortic lymphadenectomy represented the gold standard surgical treatment to assess potential nodal involvement and consequently define the appropriate stage of the tumor. Over the last years, sentinel node biopsy (SLNB) has been introduced as a more targeted alternative to lymph node dissection for lymph node staging and it has become popular among gynecologic oncologists. However, no level A evidence is still available, and several features of the SLNB technique have been matter of discussion among clinicians and a universally accepted methodology is still not currently available. This narrative review aims to summarize the body of knowledge on SLNB to offer the reader a complete picture about the evolution of this technique over the last decades.

Effects of osteopathic manipulative therapy on recurrent pelvic pain and dyspareunia in women after surgery for endometriosis: a retrospective study.

BACKGROUND: Surgical removal of deep infiltrating endometriosis is frequently associated with improvement in symptoms. However, because of the complex pathogenesis of pain in endometriosis that includes central sensitization and myofascial dysfunction, symptoms can persist after surgery. The aim of the present observational study is to explore the effectiveness of osteopathic manipulative treatment (OMT) in reducing persistent pelvic pain and dyspareunia in a sample of symptomatic women surgically treated for endometriosis. METHODS: Retrospective cohort analysis of 69 patients treated with OMT, for persistent myofascial pain, chronic pelvic pain (CPP) and dyspareunia after surgical eradication of endometriosis. Surgical, clinical and osteopathic reports were retrospectively analyzed in a chart review. Osteopathic interventions included myofascial release, balanced ligamentous/membranous tension and indirect fluidic technique. RESULTS: During the study period 345 patients underwent surgery for symptomatic endometriosis. Among them, 97 patients (28.1%) complained of post-operative persistent CPP and dyspareunia and 69 patients underwent osteopathic treatment. OMT reports showed a significant improvement of the symptoms after the first OMT session. Particularly, lower scores of CPP (mean NRS 4±4.2 vs. 0.2±0.7, P value. CONCLUSIONS: OMT, breaking the cycle of pain and normalizing the musculoskeletal pelvic activity, could be a successful technique to treat persistent chronic pain in women surgically treated for endometriosis.

How adenomyosis changes throughout pregnancy: A retrospective cohort study.

OBJECTIVE: To study how adenomyosis changes during pregnancy and to possibly correlate these changes to maternal and fetal outcomes. METHODS: Retrospective exploratory cohort study including 254 women with a pre-conceptional/first-trimester scan to document adenomyosis and known obstetric outcome. If visible, adenomyosis signs were documented in each trimester and postpartum. Mann-Whitney U tests or χ2 tests were used for continuous and categorical variables, respectively. RESULTS: A globular uterus was reported in 79% (n = 52) of women with adenomyosis in the first trimester, in 38% (n = 20) and 2% (n = 1) of women in the second and third trimesters, respectively, and postpartum in 77% (n = 34) of women. Asymmetrical thickening (n = 20, 30%) and cysts (n = 15, 23%) were only visible in 1st trimester. Adenomyosis was associated with miscarriage (odds ratio [OR] 5.9, 95% confidence interval [CI] 2.4-14.9, P < 0.001) also in normal conception only (OR 5.1, 95% CI 1.8-14.2, P = 0.002) or adjusting for maternal age (adjusted OR 5.9, 95% CI 2.3-15.2, P < 0.001). Gestational age at delivery was lower in adenomyosis (P = 0.004); the cesarean section rate was higher than in controls (OR 2.5, 95% CI 1.3-4.8, P = 0.007) also adjusting for age (adjusted OR 2.07, 95% CI 1.06-4.08, P = 0.035). CONCLUSIONS: Signs of adenomyosis were visible but progressively disappeared in pregnancy; adenomyosis was associated with an increased risk of early miscarriage. Prospective studies are needed to confirm our results.

Ultrasound-guided Needle Biopsy for Preoperative Assessment of Uterine Fibroids: Our Experience and a Review of the Literature.

Leiomyomas are the most common uterine benign tumor, and their malignant counterpart leiomyosarcomas are extremely rare. Despite this, a preoperative diagnosis could be useful for safe surgical minimally invasive management. At present, some clinical and ultrasound findings help recognizing lesions at risk of malignancy. We tried to implement a technique for the preoperative diagnosis for lesions at risk performing ultrasound-guided biopsies of suspected lesions in ten patients. Among them, one case was diagnosed as malignant by the needle biopsy. All patients underwent surgery for myomectomy or hysterectomy, and the histology was confirmed in all cases. No complications occurred. The review of the literature shows other similar experiences of preoperative biopsy of uterine lesions, showing good results for the differential diagnosis between uterine sarcoma and leiomyoma. In our experience, despite the small number of patients enrolled, this technique is safe and effective to plan minimally invasive surgery of uterine fibroids.

Hysteroscopic findings in chronic endometritis.

Chronic endometritis (CE) is a subtle pathology. Despite being difficult to detect and probably underdiagnosed, it has great clinical relevance, representing as it does a reversible cause of infertility. Nowadays, histological examination with identification of endometrial stromal plasma cells is considered the gold standard for diagnosis. Diagnostic difficulties persist, however, as a result of the technical limitations of this method and the lack of standardized histological diagnostic criteria. Hysteroscopy has been proposed as an aid for CE diagnosis. The method works by detecting signs of inflammation (focal or diffuse hyperemia, stromal edema, presence of micropolyps and the typical strawberry aspect) on the endometrial surface. Yet, the jury is still out on how reliable this technique is. Hysteroscopy displays a high sensitivity (over 86% and up to 100%) and high negative predictive value (over 92% and up to 100%) in the diagnosis of CE, and it should probably be performed routinely in the assessment of patients with unexplained infertility, repeated implantation failure and repeated pregnancy loss; however, since values in the literature regarding specificity are conflicting, in cases of suspected CE, hysteroscopy may be combined with histological examination, which remains the gold standard to confirm CE. Considering that histopathological evaluation probably underdiagnoses CE, and that hysteroscopy tends to overdiagnose, further studies are needed to determine which technique (or combination of techniques) has greater value for patients.

T-shaped uterus: what has been done, what should be done.

T-shaped uterus is a uterine malformation which has been suggested to be associated with poor reproductive performance. Over the years, different diagnostic methods have been used to determine the anatomical status of the female genital tract and to recognize any anomalies and the 3D-ultrasound is now considered the gold standard in diagnosing uterine anomalies. The importance of a correct diagnosis of the T-shaped uterus relates to the impact that such malformation has on female fertility. Although, to date, the prevalence does not seem to be so high, the fertility of the woman is reported to be somehow compromised by this uterine dysmorphism. Correcting the abnormal uterine morphology could be the main goal in order to optimize reproductive outcomes. To date, hysteroscopic correction of T-shaped uterus may be considered in patients with infertility, recurrent miscarriages or recurrent IVF failure. However, the absence of randomized controlled trials, multicentric data and the difficulty to state that metroplasty was the reason for improved outcome, make the data available inconclusive. More studies, led by an objective diagnosis, are urgently needed to understand the real impact of T-shaped uterus on the reproductive life of women and its effective prevalence in the population of infertile women.

Comparison of perioperative outcomes between standard laparoscopic and robot-assisted approach in patients with rectosigmoid endometriosis.

INTRODUCTION: Robot-assisted laparoscopic surgery (RALS) has gained widespread application in several surgical specialties. Previous studies on the feasibility and safety of RALS vs standard laparoscopy (S-LPS) for rectosigmoid endometriosis are limited and reported conflicting data. This study aims to compare S-LPS and RALS in patients with rectosigmoid endometriosis in terms of perioperative surgical and clinical data. MATERIAL AND METHODS: This is a multicentric, observational, prospective cohort study including 44 patients affected by rectosigmoid endometriosis referred to two tertiary referral centers for endometriosis from September 2018 to September 2019. Patients were divided into two groups: 22 patients underwent S-LPS, and 22 underwent RALS. Our primary outcome was to compare operative time (from skin incision to suture) between the two groups. Secondary outcomes included: operative room time (patient entry into operative room and patient out), estimated blood loss, laparotomic conversion rate, length of hospital stay, perioperative complications, and evaluation of endometriosis-related symptoms at 12-month follow up. RESULTS: The two groups were comparable regarding preoperative and surgical data, except for higher rates of hysterectomies and bilateral uterosacral ligament removal procedures in the RALS group. Also after adjusting for these discrepancies, operative time was similar between S-LPS and RALS. Operative room time was statistically longer in the RALS group compared with that of S-LPS. No statistically significant difference was found concerning other study outcomes. Pain and bowel symptoms improved in both groups at 12-month follow up. CONCLUSIONS: If performed by expert teams, RALS provides similar perioperative outcomes compared with S-LPS in rectosigmoid endometriosis surgical treatment, except for longer operative room time.

Surgical treatment of deep endometriosis with adenomyosis externa: a challenging case in an infertile woman.

OBJECTIVE: To describe the management and the fertility-enhancing potential of surgery in an infertile patient with deep-infiltrating endometriosis and adenomyosis externa. DESIGN: Video case report. SETTING: Minimally invasive and robotic gynecologic surgery unit of a university hospital. PATIENT(S): A 31-year-old nulliparous patient with dysmenorrhea, dysuria, dyspareunia, and primary infertility. INTERVENTION(S): Bimanual examination, transvaginal ultrasound, and magnetic resonance imaging (MRI) were performed as a comprehensive preoperative workup. The findings were consistent with bladder endometriosis and a 4-cm right pararectal cystic mass suggestive of adenomyosis externa. Laparoscopic excision of all visible endometriosis was performed. A pararectal lesion was found, completely developing in the retroperitoneal spaces, from the right medial pararectal space to the rectovaginal space, reaching the pelvic floor fascia without infiltration of the levator ani muscle. According to Koninckx classification, this kind of lesion corresponds to type III endometriosis or adenomyosis externa. Nerve-sparing eradication of the nodule was performed. The decision to use these techniques was taken with the intention to treat the patient, and not with the aim of testing the procedures performed. Therefore, as a common clinical practice in our institution and for the above reasons, there was no need for consultation of the institutional review board for approval. MAIN OUTCOME MEASURE(S): Improvement of symptoms and spontaneous conception after surgical removal of all endometriotic implants. RESULT(S): There were no intraoperative or postoperative complications, and the patient was discharged after 3 days. She discontinued postoperative hormone therapy with gonadotropin-releasing hormone analogue after 3 months because she desired fertility. She conceived spontaneously after 2 months of attempting. She delivered vaginally and had no complications during pregnancy and labor. Neither recurrence of pain symptoms nor voiding or rectal dysfunctions were reported by the patient. CONCLUSION(S): In the management of a case of deep endometriosis, the preoperative assessment should be carefully carried out to give the surgeon the most accurate information about the extent of the disease and the patient's main objectives. Imaging techniques such as ultrasound and MRI play a fundamental role along with the clinical evaluation in also detecting lesions that are not visible at first laparoscopic inspection. In this case of a young woman without any detectable fertility issues except for endometriosis, the laparoscopic excision of endometriosis was feasible, safe, and effective in improving the patient's fertility and pain symptoms. The fertility-enhancing potential of complete eradication of pelvic endometriosis, including removal of deep posterior localizations such those presented in this case, has been hypothesized by various investigators. It has been suggested that skilled surgical management for symptomatic deep endometriosis may be followed by a high pregnancy rate, with most pregnancies resulting from postoperative natural conception even in patients with primary infertility.

Full robotic multivisceral resections: the Modena experience and literature review.

The robotic platform is becoming a multidisciplinary tool, versatile, and suitable for multiple procedures. Combined multivisceral resections may represent an alternative to sequential procedures with a potential favorable impact on postoperative morbidity, and on the timing of administration of adjuvant chemotherapy. We herein present our initial experience with full robotic multivisceral resections, and a review of the literature available. Between January 2018 and April 2020, 11 patients underwent multivisceral full robotic abdominal surgery: 4 patients presented with two synchronous tumors, 4 with primary cancer associated with a benign condition and 3 cases involved deep infiltrating endometriosis. Surgical teams enrolled were: General Surgery, Urology and Gynecology. A systematic bibliographic research up to April 2020 was conducted in PubMed. 4 colorectal resections combined with partial or radical nephrectomy were performed, as well as 2 right colectomies in combination with right adrenalectomy and gastric banding removal, 2 radical prostatectomies with Nissen Fundoplication and abdominal wall hernia repair, and 3 resections of deep pelvic endometriosis with colorectal involvement. Mean total operative time was 367 min. No intraoperative complication or conversion to open was registered. Overall postoperative complication rate was 18.2%. 26 papers were included in the review (10 case series and 16 case reports) with a total of 156 combined multivisceral robotic procedures recorded. Robotic combined multivisceral resections proved to be safe and feasible when performed in high volume centers by expert surgeons. The heterogeneity of reports does not allow for a standardization of the procedure. Further studies and accumulation of experience are needed.

Robot-Assisted Nerve-sparing Resection of Bilateral Parametrial Deep Infiltrating Endometriosis.

OBJECTIVE: To demonstrate the surgical steps used to perform a robotic radical parametrectomy in a woman with deep infiltrating endometriosis. DESIGN: Description of the procedure using video. SETTING: University hospital, referral center for endometriosis and minimally invasive surgery. INTERVENTIONS: A 47-year-old woman, with a body mass index of 31 kg/m2, who had undergone a supracervical hysterectomy for fibromatosis 5 years earlier, presented for definitive surgical management of parametrial and rectal endometriosis-associated pain. Robot-assisted nerve-sparing eradication of endometriosis, trachelectomy, and rectal shaving were planned. On the right side, the retroperitoneum was opened to widely expose the ureter, and a right adnexectomy was performed, gently separating the ureter from the diffuse periadnexal fibrosis. Right medial pararectal space was developed, and after right partial uterolysis, a nerve-sparing resection of the posterior parametrial endometriosis was performed. On the left side, endometriotic infiltration penetrated into the lateral and anterior (cranial portion) parametrium, wrapping the left uterine artery and the ureter. Left paravesical and pararectal spaces were developed. The left uterine artery was clipped at its origin, and the resection of the lateral and anterior parametrial nodules was completed following the shape of the nodule, dividing the lesion in 2 parts, and following the plane of the deep uterine vein to avoid excision of the nerve branches from the left inferior hypogastric plexus. Rectal endometriosis was removed by shaving, and the surgery ended with trachelectomy and robotic suture of the vaginal cuff. CONCLUSION: Robot-assisted laparoscopy is a safe and effective technique for nerve-sparing resection of parametrial endometriosis.

Primary fallopian tube carcinoma (PFTC) in a BRIP-1 mutation carrier: the first case report.

Some hereditary ovarian cancer cases can be associated with a mutation of a gene involved in the DNA double-strand break repair system other than BRCA, such as BRIP1. This mutation is an emerging indication for prophylactic risk-reducing salpingo-oophorectomy (RRSO): however, anomalous tubal pathologic lesions have not yet been reported during RRSO performed for this specific indication (BRIP1), as largely reported for BRCA mutation carriers. An asymptomatic 64-year-old woman with a family history of ovarian and breast cancer agreed to undergo RRSO for a pathogenic variant of the BRIP1 gene (heterozygous NM_032043.2: c.124delT, p. Cys42Valfs) with normal BRCA genes. Histological examination showed the presence of high-grade serous carcinoma of the fimbria of the right tube of a maximum diameter of 0.4 cm (final FIGO stage IIB). The pathogenic mechanism that leads to the development of high-grade serous ovarian/fallopian tube cancer in patients with mutations of BRIP1 should be the same as for patients with mutations of BRCA1 and 2. Our case confirms to consider BRIP1 mutation to be sufficient to justify RRSO at 45-50 years old.

An unusual case of large endometrioma within the rectus abdominis muscle misdiagnosed as desmoid tumour.

We describe an unusual case of giant intramuscular abdominal endometrioma clinically misdiagnosed as desmoid tumour in a 36-year-old female patient with a one-year history of lower abdominal pain. Endometriosis is defined by the presence of endometrial tissue outside the uterine cavity, associated with fibrosis and inflammatory reaction. Although the abdominal wall is one of the most frequent sites of extra pelvic endometriosis, the localization in the anterior rectus abdominis muscle is unusual and associated with previous cesarean section. In most cases, the preoperative diagnosis is erroneous because the different imaging modalities are nonspecific but only useful in determining the extent of disease and in the planning of operative resection. A better acquaintance with the imaging presentation of abdominal wall endometriosis holds the potential of positively impact disease confirmation and may play a crucial role in the face of innovation in treatment. KEY WORDS: Desmoid tumour, Endometrioma, Surgery.

Imaging features of uterine and ovarian fibromatosis in Nevoid Basal Cell Carcinoma Syndrome.

Gorlin-Goltz Syndrome also known as Nevoid Basal Cell Carcinoma Syndrome is an autosomal dominant multisystem disorder. It is characterized by basal cell carcinomas, odontogenic keratocysts, skeletal abnormalities and in a minority of female patients bilateral calcified ovarian fibromas. It is challenging to radiologically assess ovarian fibromas as they have similar imaging patterns to some malignant ovarian lesions. However, it is vitally important to differentiate between benign and malignant lesions to determine patients' suitability for fertility-sparing surgery. This report describes a case of a 25 year-old patient with Gorlin-Goltz Syndrome and bilateral ovarian fibromas.

Use of balloon tamponade in management of severe vaginal postpartum hemorrhage and vaginal hematoma: a case series.

Severe vaginal lacerations and hematomas can be serious, life-threatening complications of vaginal delivery. The management is usually limited to suturing and vaginal packing with gauze. After a vaginal delivery vaginal tissues can be edematous, friable and very difficult to suture. Vaginal balloon tamponade can be a solution in difficult cases of intractable vaginal hemorrhage or occult vaginal bleeding causing vaginal hematoma. We describe the use of a new balloon device for vaginal hemostasis in 4 cases to treat bleeding and prevent hematoma formation from postpartum vaginal lacerations. According to our experience, the use of this balloon tamponade system in treating severe vaginal postpartum hemorrhage seems to be safe, effective and well tolerated by the patients.

Laparoscopic nerve-sparing transperitoneal approach for endometriosis infiltrating the pelvic wall and somatic nerves: anatomical considerations and surgical technique.

PURPOSE: Endometriotic or fibrotic involvement of sacral plexus and pudendal and sciatic nerves may be quite frequently the endopelvic cause of ano-genital and pelvic pain. Feasibility of a laparoscopic transperitoneal approach to the somatic nerves of the pelvis was determined and showed by Possover et al. for diagnosis and treatment of ano-genital pain caused by pudendal and/or sacral nerve roots lesions and adopted at our institution. In this paper we report our experience and anatomo-surgical consideration regarding this technique. METHODS: Confidence with this technique was obtained after several laparoscopic and laparotomic dissections on fresh, embalmed and formalin-fixed female cadavers and is now routinely performed at our institution in all cases of extensive endometriosis of the pelvic wall, involving the somatic nerves. RESULTS: We describe two different laparoscopic transperitoneal approaches to the lateral pelvic wall in case of: (A) deep pelvic endometriosis with rectal and/or parametrial involvement extending to pelvic wall and somatic nerves; (B) isolated endometriosis of pelvic wall and somatic nerves. CONCLUSIONS: Laparoscopic transperitoneal retroperitoneal nerve-sparing approach to the pelvic wall proved to be a feasible and useful procedure even if limited to referred laparoscopic centers and anatomically experienced and skilled surgeons.

Oestrogen receptor 1 mRNA is a prognostic factor in ovarian cancer patients treated with neo-adjuvant chemotherapy: determination by array and kinetic PCR in fresh tissue biopsies.

Oestrogen receptors (ESRs) regulate the growth and differentiation of normal ovarian epithelia. However, to date their role as biomarkers in the clinical setting of ovarian cancer remains unclear. In view of potential endocrine treatment options, we tested the role of ESR1 mRNA expression in ovarian cancer in the context of a neo-adjuvant chemotherapy trial. Study participants had epithelial ovarian or peritoneal carcinoma unsuitable for optimal upfront surgery and were treated with neo-adjuvant platinum-based chemotherapy before surgery. RNA was isolated from frozen tumour biopsies before treatment. RNA expression of ESR1 was determined by microarray and reverse transcriptase kinetic PCR technologies. The prognostic value of ESR1 was tested using univariate and multivariate Cox proportional hazards models, Kaplan-Meier survival statistics and the log-rank test. ESR1 positively correlates with proliferation markers and histopathological grading. ESR1 was a significant predictor of survival as a continuous variable in the univariate Cox regression analysis. In multivariate analysis, elevated baseline ESR1 mRNA levels predicted prolonged progression-free survival (P=0.041) and overall survival (P=0.01) after neo-adjuvant chemotherapy, independently of pathological grade and age. We conclude that pretreatment ESR1 mRNA is associated with tumour growth and is a strong prognostic factor in ovarian cancer, independent of the strongest clinical parameters used in clinical routine. We suggest that ESR1 mRNA status should be considered in order to minimize possible confounding effects in ovarian cancer clinical trials, and that early treatment with anti-hormonal agents based on reliable hormone receptor status determination is worth investigating.

Transvaginal evisceration after hysterectomy: is vaginal cuff closure associated with a reduced risk?

OBJECTIVE: To evaluate the overall incidence of transvaginal evisceration following hysterectomy and to assess the risk associated with indication, route of surgery, age and vaginal cuff closure technique. MATERIALS AND METHODS: A database was used to identify all patients undergoing hysterectomy from 1995 to 2001 at our institution and all the patients admitted for vaginal evisceration during the same period. Each vaginal evisceration was analyzed for time of onset, trigger event, presenting symptoms, details of prolapsed organs and type of repair surgery. RESULTS: Of the 3593 patients enrolled in the study, 63.5% underwent abdominal hysterectomy, 33.0% vaginal hysterectomy, and 3.5% laparoscopic hysterectomy. Ten patients (0.28%) presented to the emergency room with vaginal evisceration. No statistical differences in evisceration rates were seen according to the route of surgery. No differences were found between the 1440 patients who had closure of the vaginal cuff and the 2153 who had an unclosed cuff closure technique. CONCLUSIONS: Our data suggest that, in young patients, sexual intercourse is to be considered the main trigger event before the complete healing of the vaginal cuff while, in elderly patients, the evisceration is a spontaneous event. Uterine prolapse was not associated with a higher rate and the route of surgery or vaginal cuff closure technique did not influence the dehiscence rate.

Prognostic value of pelvic lymphadenectomy in surgical treatment of apparent stage I endometrial cancer.

BACKGROUND: The role of pelvic lymphadenectomy in early endometrial carcinoma is still being debated. MATERIALS AND METHODS: We retrospectively analyzed a total of 131 patients with FIGO stage I endometrial cancer undergoing surgery without (Group 1) or with (Group 2) pelvic lymphadenectomy. Kaplan-Meier and Cox analyses were used to calculate crude and adjusted survival rates. Moreover, the overlap of pre- and post-surgical staging was analyzed. RESULTS: Overall survival rate at 5 years was 90.1%. The difference in crude survival rates of the two groups is not statistically significant (p-value= 0.3777, log rank test). Five patients of Group 2 presented positive pelvic nodes. Therefore our results showed a pre-surgical understaging, referring to nodal involvement, in 9.1% of cases (5/55). CONCLUSION: Pelvic lymphadenectomy is a useful procedure for prognostic and staging purposes, but does not improve survival in FIGO stage I endometrial carcinoma.