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Surgical Treatment of Recurrent Endometrial Cancer: Time for a Paradigm Shift

  • Gynecologic Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Although surgery represents the cornerstone treatment of endometrial cancer at initial diagnosis, scarce data are available in recurrent setting. The purpose of this study was to review the outcome of surgery in these patients.

Methods

Medical records of all patients undergoing surgery for recurrent endometrial cancer at NCI Milano between January 2003 and January 2014 were reviewed. Survival was determined from the time of surgery for recurrence to last follow-up. Survival was estimated using Kaplan–Meier methods. Differences in survival were analyzed using the log-rank test. The Fisher’s exact test was used to compare optimal versus suboptimal cytoreduction against possible predictive factors.

Results

Sixty-four patients were identified. Median age was 66 years. Recurrences were multiple in 38 % of the cases. Optimal cytoreduction was achieved in 65.6 %. Median OR time was 165 min, median postoperative hemoglobin drop was 2.4 g/dl, and median length hospital stay was 5.5 days. Eleven patients developed postoperative complications, but only four required surgical management. Estimated 5-year progression-free survival (PFS) was 42 and 19 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, only residual disease was associated with PFS. Estimated 5-year overall survival (OS) was 60 and 30 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, residual disease and histotype were associated with OS. At multivariate analysis, only performance status was associated with optimal cytoreduction.

Conclusions

Secondary cytoreduction in endometrial cancer is associated with long PFS and OS. The only factors associated with improved long-term outcome are the absence of residual disease at the end of surgical resection and histotype.

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Conflict of interest

Authors declare to have no conflict of interest and no financial or material support.

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    Authors and Affiliations

    1. Division of Gynecologic Oncology, Fondazione – IRCCS – Istituto Nazionale Tumori, Milano, Milan, Italy

      Andrea Papadia MD, PhD, Filippo Bellati MD, PhD, Antonino Ditto MD, Giorgio Bogani MD, PhD, Fabio Martinelli MD, Domenica Lorusso MD & Francesco Raspagliesi MD

    2. Department of Gynecology and Obstetrics, “Sapienza” University of Rome, Rome, Italy

      Filippo Bellati MD, PhD, Maria Luisa Gasparri MD, Violante Di Donato MD, PhD & Pierluigi Benedetti-Panici MD

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    1. Andrea Papadia MD, PhD
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    2. Filippo Bellati MD, PhD
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    3. Antonino Ditto MD
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    4. Giorgio Bogani MD, PhD
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    5. Maria Luisa Gasparri MD
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    6. Violante Di Donato MD, PhD
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    9. Pierluigi Benedetti-Panici MD
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    10. Francesco Raspagliesi MD
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    Corresponding author

    Correspondence to Filippo Bellati MD, PhD.

    Additional information

    F. Bellati and A. Papadia have equally contributed to this work.

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    Papadia, A., Bellati, F., Ditto, A. et al. Surgical Treatment of Recurrent Endometrial Cancer: Time for a Paradigm Shift. Ann Surg Oncol 22, 4204–4210 (2015). https://doi.org/10.1245/s10434-015-4504-5

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    • DOI: https://doi.org/10.1245/s10434-015-4504-5

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