Cytoreductive surgery in recurrent endometrial cancer: A new paradigm for surgical management?

Range of Resection in Endometrial Cancer—Clinical Issues of Made-to-Measure Surgery

“…Other identified positive prognostic factors after secondary cytoreductive surgery were the lack of metastatic lymph nodes, negative LVSI, and endometrioid histology [72]. Interestingly, no correlation was observed between previous radiotherapy and achieving complete cytoreduction [147]. In conclusion, the available evidence from retrospective studies indicates that in recurrent EC, complete cytoreductive surgery combined with other methods (radiotherapy; chemotherapy; hormonal therapy; and, most recently, immunotherapy) provides the largest survival benefit.…”

“…Complete cytoreduction was obtained in the majority of the patients (57-75%) [147]. Importantly, for proper patient selection, factors that positively correlated with achieving complete cytoreduction were identified: solitary disease, tumor size <6 cm, and ECOG performance status of 0 [147,151]. Other identified positive prognostic factors after secondary cytoreductive surgery were the lack of metastatic lymph nodes, negative LVSI, and endometrioid histology [72].…”

“…Contrary to pelvic exenteration, cytoreductive surgery may extend beyond the pelvis and therefore can be considered a treatment option for patients with abdominal spread that were previously considered inoperable. A recent systematic review on this topic, gathering evidence from 11 retrospective studies comprising 1146 patients, concludes that cytoreduction (in combination with other methods) in recurrent endometrial cancer is associated with prolonged OS and PFS [147][148][149][150]. Similarly to ovarian cancer, completeness of resection was the most important prognostic factor, and the size of residual disease directly correlated with survival, with the reported median OS ranging from 39 to 76 months for complete debulking (no macroscopic disease) [148,151,152] and from 9 to 22 months for suboptimal debulking (>1 cm of residual disease) [151,153].…”

“…Similarly to ovarian cancer, completeness of resection was the most important prognostic factor, and the size of residual disease directly correlated with survival, with the reported median OS ranging from 39 to 76 months for complete debulking (no macroscopic disease) [148,151,152] and from 9 to 22 months for suboptimal debulking (>1 cm of residual disease) [151,153]. Complete cytoreduction was obtained in the majority of the patients (57-75%) [147]. Importantly, for proper patient selection, factors that positively correlated with achieving complete cytoreduction were identified: solitary disease, tumor size <6 cm, and ECOG performance status of 0 [147,151].…”