title: Surgical Treatment of Recurrent Endometrial Cancer: Time for a Paradigm Shift.
abstract: BACKGROUND
  Although surgery represents the cornerstone treatment of endometrial cancer at initial diagnosis, scarce data are available in recurrent setting. The purpose of this study was to review the outcome of surgery in these patients.
  
  
  METHODS
  Medical records of all patients undergoing surgery for recurrent endometrial cancer at NCI Milano between January 2003 and January 2014 were reviewed. Survival was determined from the time of surgery for recurrence to last follow-up. Survival was estimated using Kaplan-Meier methods. Differences in survival were analyzed using the log-rank test. The Fisher's exact test was used to compare optimal versus suboptimal cytoreduction against possible predictive factors.
  
  
  RESULTS
  Sixty-four patients were identified. Median age was 66 years. Recurrences were multiple in 38 % of the cases. Optimal cytoreduction was achieved in 65.6 %. Median OR time was 165 min, median postoperative hemoglobin drop was 2.4 g/dl, and median length hospital stay was 5.5 days. Eleven patients developed postoperative complications, but only four required surgical management. Estimated 5-year progression-free survival (PFS) was 42 and 19 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, only residual disease was associated with PFS. Estimated 5-year overall survival (OS) was 60 and 30 % in optimally and suboptimally cytoreduced patients, respectively. At multivariate analysis, residual disease and histotype were associated with OS. At multivariate analysis, only performance status was associated with optimal cytoreduction.
  
  
  CONCLUSIONS
  Secondary cytoreduction in endometrial cancer is associated with long PFS and OS. The only factors associated with improved long-term outcome are the absence of residual disease at the end of surgical resection and histotype.
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Papadia
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy. filippo.bellati@uniroma1.it.|Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy. filippo.bellati@uniroma1.it.
authors.forename: Filippo
authors.initials: F
authors.lastname: Bellati
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Antonino
authors.initials: A
authors.lastname: Ditto
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Bogani
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Maria Luisa
authors.initials: ML
authors.lastname: Gasparri
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Violante
authors.initials: V
authors.lastname: Di Donato
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Fabio
authors.initials: F
authors.lastname: Martinelli
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Domenica
authors.initials: D
authors.lastname: Lorusso
authors.affiliation: Department of Gynecology and Obstetrics, "Sapienza" University of Rome, Rome, Italy.
authors.forename: Pierluigi
authors.initials: P
authors.lastname: Benedetti-Panici
authors.affiliation: Division of Gynecologic Oncology, Fondazione - IRCCS - Istituto Nazionale Tumori, Milano, Milan, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Raspagliesi
mesh_terms: D018262:Adenocarcinoma, Clear Cell / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002291:Carcinoma, Papillary / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018284:Cystadenocarcinoma, Serous / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016889:Endometrial Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D009367:Neoplasm Staging; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D002583:Uterine Cervical Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*