Surgical treatment of recurrent endometrial carcinoma

• Published in: Cancer 2004-01, Vol.100 (1), p.89-96
• Main Authors: Campagnutta, Elio, Giorda, Giorgio, De Piero, Giovanni, Sopracordevole, Francesco, Visentin, M. Caterina, Martella, Luca, Scarabelli, Carlo
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma - mortality; Carcinoma - pathology; Carcinoma - surgery; endometrial neoplasms; Endometrial Neoplasms - mortality; Endometrial Neoplasms - pathology; Endometrial Neoplasms - surgery; Female; Humans; Medical sciences; Middle Aged; Neoplasm Recurrence, Local - pathology; Neoplasm Recurrence, Local - surgery; Neoplasm, Residual; Patient Selection; Postoperative Complications; recurrence; Retrospective Studies; Salvage Therapy; surgery; Survival Analysis; Treatment Outcome; Tumors
• ISSN: 0008-543X; 1097-0142
• DOI: 10.1002/cncr.11868

BACKGROUND Surgery does not have a definite role in the treatment of patients with recurrent endometrial carcinoma, except for those with central pelvic recurrences. The authors describe their experience with surgery in patients with abdominal endometrial recurrences. METHODS Between 1988 and 2000, 75 patients with abdominal and pelvic endometrial recurrences underwent secondary rescue surgery. Patients were classified according to the presence or absence of residual tumor after surgery. Therapy after rescue surgery was undertaken at the discretion of the medical oncologist. The progression‐free interval and overall survival were defined as the time from secondary rescue surgery to the specific event and were evaluated by the Kaplan–Meier method and the log‐rank test. A Cox proportional hazards regression model was used to compare survival with covariates. RESULTS Fifty‐six patients (74.7%) underwent optimal debulking. Major surgical complications were observed in 23 patients (30.7%). Only 1 postoperative death was observed, although the mortality rate for surgical complications after the postoperative period was 8%. Patients who underwent optimal debulking had a significantly better cumulative survival rate compared with patients who had residual disease (36% vs. 0% at 60 months; P < 0.05). Residual disease, chemotherapy after rescue surgery, and central pelvis–vagina as the only site of recurrence were associated significantly with survival. CONCLUSIONS The authors found that this approach was very challenging in terms of the procedures involved, the incidence of major surgical complications, and the high mortality rate. It was useful in increasing overall survival, provided that patients were free of macroscopic disease. Careful selection of patients is needed to minimize mortality. Cancer 2004;100:89–96. © 2003 American Cancer Society. Surgery is effective in the treatment of endometrial carcinoma recurrences, although it is fraught with major complications and a high mortality rate. Careful selection of patients is required.