Introduction There is a lack of consensus regarding the surgical management of advanced-stage endometrial cancer. We aim to look at survival outcomes of advanced-stage carcinoma endometrium, managed through surgery and adjuvant treatment.

Methods This was a retrospective study from a tertiary care cancer centre in India that included all women registered between 1st August 2011 and 31st January 2021 with operable advanced-stage carcinoma endometrium (stages 3 and 4). Their relevant data were collected from electronic medical records.

Results Out of 1760 endometrial cancer cases screened 102 women with stage 3 and 4 disease were operable. The mean age was 59 years. Most women were parous (85%) with an ECOG status of 0 or 1 (90%). Histopathology was high grade in 73 women (71.6%). Surgeries performed were: Staging surgery 50(49%), debulking surgery 38(37.2%), surgery after chemotherapy 6(5.8%). Eight women (7.8%) were operable but given only chemotherapy for various reasons. 72 (76.6%) patients received planned adjuvant treatment. Overall, 50 patients (56.8%) were upstaged after surgery. At the time of analysis, 32 (31.4%) women were alive without disease. Median disease-free survival of stage 3, stage 4 and both combined were 32.8 months (95%CI: 0–87), 19 months (7.6–30.3), and 23.5 months (95% CI: 13.7–33.2) respectively. Median overall survival was not reached for stage 3. For stage 4 and both combined, it was 41 months (95% CI: 18.8–63.1) and 50.1 months (95% CI: 31.2–69.1) respectively.

Conclusion/Implications Upfront surgery in advanced-stage endometrial carcinoma gives a respectable survival outcome after maximal surgical attempt.