SURGICAL MANAGEMENT OF ADVANCED OR RECURRENT ENDOMETRIAL CANCER

Abstract

In the United States, cancer of the epithelial lining (endometrium) of the uterine corpus is the fourth most common malignancy diagnosed in women and ranks seventh among causes of cancer deaths in females.²⁹ Since 1972, endometrial cancer has been the most common female pelvic malignancy reported by the American Cancer Society. They estimate that 36,100 newly diagnosed cases and 6500 deaths caused by the disease in the United States occurred in 2000.²⁹

At the time of diagnosis, in most cases (approximately 75%), the disease is confined to the uterus; in these cases, the overall survival rate at 5 years is 80% to 90%.¹⁹ Numerous prospective, cooperative group studies have been performed to determine the most effective management of patients with early stage I and II endometrial cancer.8, 18, 22, 39, 46 Patients who have surgical stage III disease on the basis of microscopic metastases to the adnexae, vagina, or retroperitoneal lymph nodes typically are given postoperative radiotherapy.39, 40, 42, 47

In part because less than 15% of patients with endometrial cancer have gross evidence of metastatic disease at initial clinical or surgical evaluation, much less data are available in the literature evaluating the role of surgery in the management of patients with advanced disease. Furthermore, only a few studies have examined the impact of surgery in recurrent endometrial cancer. Although limited, published data indicate that aggressive surgical resection can significantly improve the outcomes of patients with advanced and recurrent disease. This article reviews the role of surgery in the management of advanced and recurrent endometrial cancer.