The role of surgical cytoreduction in Stage IV endometrial carcinoma

To evaluate the impact of surgical cytoreduction in patients (pts) with Stage IV endometrial adenocarcinoma.

We performed a retrospective chart review of all pts with Stage IV endometrial carcinoma treated at our institution from January, 1977, to February, 1995.

Fifty-five patients who underwent surgery as part of their primary treatment for Stage IV endometrial carcinoma were identified. They were divided into three groups: Group I consisted of 24 pts (44%) who underwent optimal surgical cytoreduction (diameter of largest residual tumor nodule < or = 2 cm); Group II contained 21 pts (38%) who underwent suboptimal surgical cytoreduction (> 2 cm residual disease); Group III consisted of 10 pts (18%) who had unresectable carcinomatosis and had no cytoreduction at all. There were no statistically significant differences between the three groups with respect to median age at diagnosis, tumor grade, histologic subtype, or the presence of extra-abdominal metastases. The median survival rates for the three groups were I, 31 months; II, 12 months; and III, 3 months (P < 0.01). Within Group I, there was no statistically significant difference in survival between the 8 pts who were found at laparotomy to have metastatic disease < or = 2 cm and the 16 pts who initially had metastatic disease > 2 cm and were subsequently cytoreduced to optimal status. On multivariate analysis only the extent of surgical cytoreduction had prognostic significance on survival.

The prognosis of Stage IV endometrial carcinoma is poor. However, the data in this series suggest that aggressive tumor cytoreduction may improve survival in these patients.