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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 13/2015

01-12-2015 | Gynecologic Oncology

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

Authors: Andrea Papadia, MD, PhD, Filippo Bellati, MD, PhD, Antonino Ditto, MD, Giorgio Bogani, MD, PhD, Maria Luisa Gasparri, MD, Violante Di Donato, MD, PhD, Fabio Martinelli, MD, Domenica Lorusso, MD, Pierluigi Benedetti-Panici, MD, Francesco Raspagliesi, MD

Published in: Annals of Surgical Oncology | Issue 13/2015

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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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Metadata
Title
Surgical Treatment of Recurrent Endometrial Cancer: Time for a Paradigm Shift
Authors
Andrea Papadia, MD, PhD
Filippo Bellati, MD, PhD
Antonino Ditto, MD
Giorgio Bogani, MD, PhD
Maria Luisa Gasparri, MD
Violante Di Donato, MD, PhD
Fabio Martinelli, MD
Domenica Lorusso, MD
Pierluigi Benedetti-Panici, MD
Francesco Raspagliesi, MD
Publication date
01-12-2015
Publisher
Springer US
Published in
Annals of Surgical Oncology / Issue 13/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-015-4504-5

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