How would you counsel a patient with incidental diagnosis of at least high intermediate risk endometrial cancer, found on robotic hysterectomy with non-contained uterine morcellation and no node sampling?

MELF pattern of invasion has a higher rate of LN involvement, reported as 18% in one series (Joehlin-Price et al., PMID 27740968) and as high as 54% in an older series (Pavlakis et al., PMID 21438907).

In the setting of an unstaged patient, a discussion of lymphadenectomy vs whole pelvis RT would be reasonable, IMO. Likely in all patients, but especially in someone who otherwise meets HIR criteria and would be recommended brachytherapy anyways, I would favor whole pelvis in an unstaged patient with MELF invasion rather than lymphadenectomy for toxicity profile and lack of survival benefit of lymphadenectomy (although has not been studied in the subgroup of MELF positive patients).

What to make of the non-contained uterine morcellation, I am n...