The role of radical surgery in carcinoma of the endometrium

A minority of women with endometrial cancer present with disease beyond the uterine corpus. Where disease has spread to the uterine cervix, extended or radical surgery may be curative without the need for adjuvant treatment. Radical surgery has a potential major role in the management of locally advanced disease together with adjuvant radiotherapy and/or chemotherapy. Radical pelvic surgery remains the only curative option for isolated pelvic recurrence in the previously irradiated patient. A number of published studies report a survival benefit from surgical cytoreduction in women with extra-pelvic metastases and recurrent disease, although the degree of surgical effort required in order to achieve an optimal result varies. Women with a single site of metastasis or recurrence seem most likely to benefit. However, the value of radical pelvic and abdominal procedures in advanced and recurrent disease must be balanced against the associated high morbidity and the resulting quality of life for the individual woman. Many women with endometrial cancer are elderly and have limiting co-morbidities. The treatment modality and the appropriate extent of surgery must therefore be determined on an individual patient basis.