title: Optimal surgical cytoreduction in patients with Stage III and Stage IV endometrial carcinoma: a study of morbidity and survival.
abstract: OBJECTIVE
  To evaluate the survival impact of residual disease at the time of primary surgery for patients with Stage III and IV endometrial carcinoma; to assess morbidity associated with surgical cytoreduction.
  
  
  METHODS
  All patients with endometrial carcinoma who underwent primary surgical therapy at the University of Miami between January 1, 1990 and June 1, 2002 were identified. Patients meeting FIGO criteria for Stage III or IV disease were selected. Papillary serous and clear cell histology was excluded.
  
  
  RESULTS
  Eighty-five patients were identified: 66 Stage III and 19 Stage IV. Only Stage IIIC and Stage IV were included in survival analysis: 72% (33 Stage IIIC, 9 Stage IV) had optimal cytoreduction and 28% (6 Stage IIIC, 10 Stage IV) had suboptimal cytoreduction. The median survival for Stage IIIC and IV disease was 6.7 months for patients with suboptimal cytoreduction and 17.8 months for patients with optimal cytoreduction (P = 0.001). The proportion of patients with major postoperative complications (37.50% vs. 7.25%, P = 0.005), unplanned postoperative SICU admissions (31.25% vs. 7.25%, P = 0.018), and length of hospital stay exceeding 15 days (31.25% vs. 4.35%, P = 0.005) was greater in patients with suboptimal cytoreductive surgery.
  
  
  CONCLUSIONS
  Overall survival is lower and morbidity is higher in patients with advanced endometrial carcinoma having suboptimal cytoreduction at the time of primary surgery. Patients with suspected advanced stage endometrial carcinoma should be counseled on the potential benefits of optimal cytoreductive surgery. Alternative treatment options should be considered in those patients with surgically unresectable disease.
authors.affiliation: Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Miami School of Medicine, Miami, FL 33136, USA. nlambrou@med.miami.edu
authors.forename: Nicholas C
authors.initials: NC
authors.lastname: Lambrou
authors.forename: Orlando
authors.initials: O
authors.lastname: Gómez-Marín
authors.forename: Ramin
authors.initials: R
authors.lastname: Mirhashemi
authors.forename: Heather
authors.initials: H
authors.lastname: Beach
authors.forename: Emery
authors.initials: E
authors.lastname: Salom
authors.forename: Zoyla
authors.initials: Z
authors.lastname: Almeida-Parra
authors.forename: Manuel
authors.initials: M
authors.lastname: Peñalver
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018196:Carcinoma, Adenosquamous / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D018269:Carcinoma, Endometrioid / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery; D017024:Chemotherapy, Adjuvant; D016889:Endometrial Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy / Q000601:surgery*; D005260:Female; D006801:Humans; D008875:Middle Aged; D009017:Morbidity; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D015996:Survival Rate