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. 2023 Aug 15;83(8):963–995. doi: 10.1055/a-2066-2068
No. Recommendations/Statements GoR LoE Sources
5.11 In the presence of early endometrial carcinoma (endometrioid, pT1a G1), total hysterectomy with bilateral adnexal extirpation results in a disease-specific 5-year survival of 99%. A 3 9
5.12 In the presence of endometrioid endometrial carcinoma G1, G2 pT1a, the ovaries may be left in place when performing hysterectomy and bilateral salpingectomy in premenopausal women, provided there is no evidence of hereditary predisposition to ovarian cancer (e.g., BRCA mutation, certain forms of Lynch syndrome) and the patient is informed of the risk. EC
5.13 In women with incomplete family planning and endometrioid cT1a without myometrial infiltration, G1, p53-wt and L1CAM-negative endometrial carcinoma and a desire for fertility preservation, the uterus and adnexa can be left in place if the patient has been informed that the standard treatment almost always leading to cure is total hysterectomy and that the patient temporarily forgoes curative treatment of a malignancy on her own responsibility, knowing the potentially fatal consequences (progression of the disease, metastasis) even if a pregnancy is carried to term. EC
5.14 If uterus preservation is desired, the uterus and adnexa can be preserved in the presence of endometrioid cT1a, without myometrial infiltration G1, p53-wt, and L1CAM-negative endometrial carcinoma if the patient has been recommended a consultation with a specialist in reproductive medicine to assess the chances of fulfilling a childbearing desire. EC
5.15 If uterus preservation in endometrioid cT1a, without myometrial infiltration G1, p53-wt and L1CAM-negative endometrial carcinoma are desired, the uterus and adnexa can be left in place if the patient agrees to close monitoring and has been informed of the need for hysterectomy after fulfillment or abandonment of the desire to have children. EC
5.16 In endometrioid cT1a without myometrial infiltration, G1, p53-wt and L1CAM- negative endometrial carcinoma and desire for fertility preservation, the uterus and adnexa can be left in place if a diagnosis of well-differentiated (G1) endometrioid EC expressing progesterone receptors has been made by hysteroscopy with targeted biopsy or with dilatation and curettage and evaluation by a pathologist experienced in gynecologic pathology. EC
5.17 In endometrioid cT1a without myometrial infiltration, G1, p53-wt, and L1CAM-negative endometrial cancer and desire for fertility preservation, the uterus and adnexa can be left in place if laparoscopy with vaginal ultrasound or if MRI has ruled out adnexal involvement or myometrial infiltration as much as possible. EC
5.18 In endometrioid cT1a without myometrial infiltration, G1, p53-wt, and L1CAM-negative endometrial cancer and desire for fertility preservation, the uterus and adnexa can be left in place if sufficient drug treatment is given with medroxyprogesterone acetate 200 – 250 mg/d/p. o.) or megestrol acetate (160 – 200 mg/d/p. o.) or a levonorgestrel IUD (52 mg). EC
5.19 If a complete remission of the endometrial carcinoma is diagnosed after six months of conservative treatment, the planned pregnancy should be pursued in cooperation with a specialist in reproductive medicine if necessary. EC
5.20 Patients with endometrioid cT1a without myometrial infiltration, G1, p53-wt, and L1CAM-negative endometrial cancer without a current desire to have children should receive maintenance therapy (levonorgestrel-IUD, oral contraceptives, cyclic progestins) and have an endometrial biopsy every 6 months. EC
5.21 If there is no remission of the carcinoma after six months of conservative treatment, hysterectomy should be performed. EC
5.22 If uterus preservation is desired, the uterus and adnexa can be left in the presence of endometrioid endometrial cancer (cT1a, G1, p53-wt, and L1CAM-negative) if the following conditions are met:
  • Information that the standard treatment almost always leading to cure is total hysterectomy,

  • Consent with close follow-up,

  • Information about the necessity of hysterectomy after fulfillment or abandonment of the desire to have a child,

  • Hysteroscopy with targeted biopsy or dilatation and curettage to confirm diagnosis,

  • Laparoscopy with vaginal ultrasound or MRI to rule out adnexal involvement/myometrial infiltration,

  • Diagnosis made or confirmed by a pathologist experienced in gynecologic pathology,

  • Treatment with MPA or MGA or LNG-IUD (52 mg),

  • After 6 months, repeat hysteroscopy withdilatation and curettage as well as imaging. If no remission, hysterectomy,

  • If complete remission, aim for pregnancy (expert in reproductive medicine),

  • If no current desire to have children: maintenance therapy and endometrial biopsy every 6 months,

  • after fulfillment or abandonment of the desire to have children: total hysterectomy and bilateral adnexal extirpation recommended.

EC