Hindawi Publishing Corporation Obstetrics and Gynecology International Volume 2010, Article ID 181963, 8 pages doi:10.1155/2010/181963 Review Article Controversies in Surgical Staging of Endometrial Cancer R. Seracchioli, S. Solfrini, M. Mabrouk, C. Facchini, N. Di Donato, L. Manuzzi, L. Savelli, and S. Venturoli Minimally Invasive Gynaecological Surgery Unit, S. Orsola-Malpighi Hospital, University of Bologna, 40138 Bologna, Italy Correspondence should be addressed to R. Seracchioli, renato.seracchioli@aosp.bo.it Received 7 October 2009; Revised 9 February 2010; Accepted 30 May 2010 Academic Editor: E. Hernandez Copyright © 2010 R. Seracchioli et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Endometrial cancer is the most common gynaecological malignancy and its incidence is increasing. In 1998, international federation of gynaecologists and obstetricians (FIGO) required a change from clinical to surgical staging in endometrial cancer, introducing pelvic and paraaortic lymphadenectomy. This staging requirement raised controversies around the importance of determining nodal status and impact of lymphadenectomy on outcomes. There is agreement about the prognostic value of lymphadenectomy, but its extent, therapeutic value, and beneﬁts in terms of survival are still matter of debate, especially in early stages. Accurate preoperative risk stratiﬁcation can guide to the appropriate type of surgery by selecting patients who beneﬁt of lymphadenectomy. However, available preoperative and intraoperative investigations are not highly accurate methods to detect lymph nodes and a complete surgical staging remains the most precise method to evaluate extrauterine spread of the disease. Laparotomy has always been considered the standard approach for endometrial cancer surgical staging. Traditional and robotic- assisted laparoscopic techniques seem to provide equivalent results in terms of disease-free survival and overall survival compared to laparotomy. These minimally invasive approaches demonstrated additional beneﬁts as shorter hospital stay, less use of pain killers, lower rate of complications and improved quality of life. 1. Introduction Endometrial cancer is one of the most common gynaecolog- ical malignancies in developed countries and, unfortunately, the incidence of endometrial cancer is rising. This may be attributed to risk factors, like increased life expectancy, obesity, diabetes, late menopause, and use of Tamoxifen [1– 3]. Endometrial cancer spreads towards myometrial wall, cervix, and lymphatic stations of pelvic and paraaortic lymph nodes [4]. Prognosis of this malignancy depends on various factors: histological type of the tumour, the depth of invasion into the myometrium, and lymph node involvement [1–4]. Surgical management of endometrial cancer is a chal- lenge. It is important to balance risks and beneﬁts of each surgical option, avoiding both over- and undertreatment. The Gynaecologic Oncology Group (GOG) trial pub- lished in 1987, lead to a crucial change from clinical to surgical staging. By this study, pelvic and paraaortic lymphadenectomy have been introduced in the oncolog- ical practice of endometrial cancer on the basis of the international federation of gynaecologists and obstetricians (FIGO) criteria [5]. The new FIGO classiﬁcation addressed new information about prognostic predictors. However, the extent of surgical staging, the deﬁnition of high-risk patients who beneﬁt from complete staging, numbers of lymph nodes, and anatomical limits in paraaortic area still lack standardisation [6–10]. In the present manuscript, we sought to review the available evidences and to discuss controversies in surgical management of endometrial cancer, considering the follow- ing items: (1) Complete surgical staging: Role of lymphadenectomy in endometrial cancer; (2) Preoperative evaluation: Predictors of lymph node metastasis; (3) Intraoperative detection of lymph node metastasis; (4) Extent of lymphadenectomy; (5) Surgical approach for staging of endometrial cancer.