Impact of optimal secondary cytoreductive surgery on survival outcomes in women with recurrent endometrial carcinoma: A systematic review and meta-analysis

Abstract

Background

Management of recurrent endometrial carcinoma (EC) represents a challenge. Although a complete resection of visible disease at secondary surgery (R0) is recommended, the impact of R0 on survival outcomes is unclear and pooled data are lacking.

Objective

To quantitatively assess the impact of R0 on survival outcomes in women with EC recurrence.

Search Strategy

A systematic review and meta-analysis was performed searching eight electronic databases from their inception up to January 2024.

Selection Criteria

All peer-reviewed studies that assessed quantitatively the impact of R0 on survival outcomes in women at first EC recurrence were included.

Data Collection and Analysis

Hazard ratio (HR) with 95% confidence interval (CI) for death of any cause and secondary recurrent or progressive disease in women with EC recurrence who underwent R0 compared to non-optimal secondary surgical cytoreduction (R1) were pooled and assessed at both univariable and multivariable analyses.

Main Results

Three studies with 442 patients were included. At univariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.451 (95% CI: 0.319–0.638) for death from any cause, and 0.517 (95% CI: 0.298–0.895; p = 0.019) for recurrent or progressive disease.

At multivariate analysis, in women with EC recurrence and R0 compared to women with EC recurrence and R1, pooled HR was 0.447 (95% CI: 0.255–0.783; p = 0.005) for death from any cause, and 0.585 (95% CI: 0.359–0.952; p = 0.031) for recurrent or progressive disease.

Conclusion

In women with EC recurrence, R0 is an independent prognostic factor, decreasing the risk of death from any cause by approximatively 55%, and of recurrent or progressive disease by approximatively 40%, compared to R1.