Modified radical hysterectomy versus extrafascial hysterectomy in the treatment of stage I endometrial cancer: results from the ILIADE randomized study

Ann Surg Oncol. 2009 Dec;16(12):3431-41. doi: 10.1245/s10434-009-0736-6. Epub 2009 Oct 16.


Background: Five percent to 20% of stage I endometrial cancer patients undergoing total abdominal hysterectomy and bilateral salpingo-oophorectomy develop vaginal and pelvic recurrences. Adjuvant radiotherapy can improve locoregional control but not survival. This randomized trial aimed to determine whether a modified radical (Piver-Rutledge class II) hysterectomy can improve survival and locoregional control compared to the standard extrafascial (Piver-Rutledge class I) hysterectomy.

Methods: Eligible patients (n = 520) with stage I endometrial cancer were randomized to class I or class II hysterectomy. Primary endpoint was overall survival.

Results: The median length of parametria and vagina removed were 15 and 5 vs. 20 mm and 15 mm for class I and class II hysterectomy, respectively (P > 0.001). Operating time and blood loss were statistically significantly higher for class II hysterectomy. At a median follow-up of 70 months, 51 patients had died. Five-year disease-free and overall survival were similar between arms (87.7 and 88.9% in the class I arm and 89.7 and 92.2% in the class II arm, respectively). The unadjusted hazard ratios for recurrence was 0.91 (95% confidence interval, 0.55-1.51, P = 0.72), and the hazard ratio for death was 0.77 (95% confidence interval, 0.44-1.33, P = 0.35).

Conclusions: Class II hysterectomy did not improve locoregional control and survival compared to class I hysterectomy, but when an adequate vaginal cuff transection is not feasible with class I hysterectomy, a modified radical hysterectomy allows to obtain an optimal vaginal and pelvic control of disease with a minimal increase in surgical morbidity.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adenocarcinoma, Clear Cell / pathology
  • Adenocarcinoma, Clear Cell / surgery*
  • Adenocarcinoma, Mucinous / pathology
  • Adenocarcinoma, Mucinous / surgery*
  • Adolescent
  • Adult
  • Aged
  • Carcinoma, Adenosquamous / pathology
  • Carcinoma, Adenosquamous / surgery*
  • Cystadenocarcinoma, Serous / pathology
  • Cystadenocarcinoma, Serous / surgery*
  • Endometrial Neoplasms / pathology
  • Endometrial Neoplasms / surgery*
  • Female
  • Follow-Up Studies
  • Humans
  • Hysterectomy / methods*
  • Middle Aged
  • Neoplasm Staging
  • Prognosis
  • Survival Rate
  • Treatment Outcome
  • Young Adult