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Surgery for Recurrent Uterine Cancer: Surgical Outcomes and Implications for Survival—A Case Series
  1. Lavinia Domenici, MD*,
  2. Katherine Nixon, MD,,
  3. Flavia Sorbi, MD§,
  4. Maria Kyrgiou, PhD, MD,,
  5. Joseph Yazbek, MD, PhD,,
  6. Marcia Hall, MD,
  7. Jeremy Campbell, MD, PhD,
  8. Norma Gibbons, MD#,
  9. Won-Ho Edward Park, MD,
  10. Hani Gabra, MD, PhD, and
  11. Christina Fotopoulou, MD, PhD,
  1. * Department of Gynecology-Obstetrics and Urology, Sapienza University of Rome, Rome, Italy;
  2. West London Gynaecological Cancer Centre, Imperial College Healthcare NHS Trust;
  3. Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, London, United Kingdom;
  4. § Division of Obstetrics and Gynecology, Department of Biomedical, Clinical and Experimental Sciences, University of Florence, Florence, Italy;
  5. Mount Vernon Cancer Centre, London, United Kingdom;
  6. Department of Anaesthetics, Hammersmith Hospital, Imperial College Healthcare NHS Trust; and
  7. # Department of Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
  1. Address correspondence and reprint requests to Christina Fotopoulou, MD, PhD, Ovarian Cancer Action Research Centre, Department of Surgery and Cancer, Imperial College London, Du Cane Rd, London W12 0NN, United Kingdom. E-mail: chfotopoulou{at}gmail.com.

Abstract

Objective The purpose of this study was to describe the patterns of relapse in uterine cancer (UC) and the role of surgery in the recurrent setting.

Methods We describe surgical and clinical outcomes of all patients who underwent surgery for recurrent UC in a gynecological oncology tertiary referral center between May 1, 2013, and April 30, 2016. Progression-free survival and overall survival were estimated using Kaplan-Meier methods with the surgery at relapse being the starting point.

Results We evaluated 15 patients with a median age of 66 years. The predominant histology was the endometrioid variant (n = 11; 73.3%). The median interval between the end of previous treatment and relapse surgery was 24 months (range, 8–164). Locoregional pelvic recurrences were the most common type of recurrence (n = 13; 86.7%) with the para-aortic lymph node space being the most commonly affected extrapelvic site (13%). Patients predominantly presented with a multifocal pattern of relapse (n = 10; 66.7%) requiring multivisceral resections such as bowel (n = 7; 46.6%) and/or bladder/ureteric resections (n = 8; 53.3%) to achieve complete tumor clearance. All patients were operated tumor free with a 30-day major morbidity and mortality rate of 6.7% and 0%, respectively. Five patients (33.3%) received postoperative chemotherapy or radiotherapy. Five patients (33.3%) relapsed, and 3 died within a mean follow-up of 12.4 months (95% confidence interval [CI], 6.5–18.2). Two of those patients had a sarcoma.

Mean progression-free survival and overall survival for the entire cohort postrelapse surgery was 21.7 months (95%CI, 13.9–29.5) and 26.0 months (95%CI, 18.4–33.7), respectively. Survival was significantly worse in patients with nonendometrioid histology (P < 0.0001).

Conclusions Surgery for UC relapse seems feasible with acceptable morbidity and high complete resection rates despite the multifocal patterns of relapse in a selected group of patients in a reference center for gynecological cancers. Larger scale studies are warranted to establish the value of surgery at relapse for UC.

  • Uterine cancer
  • Surgery
  • Relapse

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Footnotes

  • The authors declare no conflicts of interest.

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